INFLUENCE OF FIXED VERSUS FREE PHARMACOLOGICAL COMBINATIONS IN THE MANAGEMENT OF ARTERIAL HYPERTENSION: PP.5.170

Abstract

Objectives: To compare the effect of fixed-dose combinations (FiDC) versus free-dose combinations (FrDC) in hypertensive patients, in terms of reduction of blood pressure (BP) values and achievement of BP goals. Design and Method: Longitudinal retrospective cohort study in patients attended at our Hypertension Unit from january 2006 until september 2009. All consecutive hypertensive patients treated with monotherapy, who did not achieve BP goals, were included in the study. A second farmacological agent according to usual clinical practice was added in the initial visit with evaluation one year later. Results: We included 169 hypertensive patients on monotherapy (90 men, 53,3 %, median age 57,7 years) and a BMI of 30,2 kg/m2. 84 patients initiated a second antiypertensive agent on a free basis, the resting 85 patients received a fixed-dosed combination. There were no statistically significant differences in age or initial office BP. The most prevalent combination strategies in both groups were ACEI/diuretics and ARB/diuretics, accounting for almost 90 % of the combination treatment (86% in the FrDC versus 94% in the FiDC-group). In the FiDC-group arterial BP was reduced from initially 149/85 to 128/75 mmHg, in the FrDC-group from 147/84 to 134/77 mmHg. Differences between intitial and final systolic (20.6 vs. 12.2, p = 0.001) and diastolic (10.1 vs. 6.8, p = 0.029) BP were significantly greater in the FiDC than in the FrDC-group. The proportion of patients achieving blood pressure goals in the FiDC-group was significantly greater (88%) than the corresponding proportion in the FrCD-group (69%, p < 0,01). There were no statistical differences between groups in the number of antihypertensive drugs (2.12 FrDC versus 2.22 FiDC). Conclusions: Management of hypertension based on fixed-dose combinations, compared to free-dose combinations, leads to a greater reduction of initial systolic and diastolic BP and to a higher proportion of patients achieving BP goals, suggesting that strategies based on fixed-dose combinations improve the patients' compliance as a determinant factor of BP control.