Influencia del cumplimiento asociado a la incidencia de eventos cardiovasculares y los costes en combinaciones a dosis fijas en el tratamiento de la hipertensión arterial

Abstract

To determine the incidence of cardiovascular events (CVE) and health care costs in relation to compliance, persistence and level of blood pressure control when comparing patients treated with single-pill combinations (SPC) or free combinations (FC) for the treatment of hypertension.Observational, multicenter study that included patients>30 years old, from six primary care teams and two hospitals, who started pharmacological treatment for hypertension during 2006. Two study groups were established: SPC (ACEIs/diuretics; ARBs/diuretics) and FC (ACEIs+DIU; ARB+DIU, separately). Main variables studied were sociodemographic data, comorbidity, Charlson-index, compliance, persistence and achievement of therapeutic goals (ESH-ESC criteria). The cumulative incidence of CVE and a total-cost model were determined (differentiating: health/direct; non-health/indirect). Patients were followed for two years. Statistical analysis included logistic regression, Cox proportional hazards model and analysis of covariance. Statistical signification: p<0.05.1,605 patients were recruited, 1,112 (69.3%) receiving SPC and 493 (30.7%) receiving FC, p<0.001; mean age: 69.4 (12.2) years; women: 55.5%. FC treatments were associated with ischaemic heart disease (OR=1.4; 95% CI: 1.1-2.0) and organ failure (OR=1.5; 95% CI: 1.2-2.1), p<0.031. Patients on SPC showed better therapeutic compliance (77.6% vs 71.9%; p<0.001) and longer persistence of treatment (62.1% on-treatment at 24-months [95% CI: 56.3-67.9] vs 49.7% [95% CI: 38.5-60.9]; p<0.001). Optimal control of blood pressure was higher in SPC (48.9% [95% CI: 43.0-54.8] vs 46.7% [95% CI: 35.6-57.8]; p<0.001). Cumulative incidence of cerebrovascular accidents in FC was 4.6% vs 2.4% in SPC; p=0.041. The total health care costs were lower in SPC (1,650.7 € vs 1,674.8 €; p<0.001), including lower specialized care costs (316.1 € vs 382.9 €; p<0.001), fewer hospital admissions and less loss of labour productivity (44.5 € vs 88.4 €; p<0.001).Better compliance and persistence with antihypertensive fixed-dose combinations improves therapeutic control, leading to a significant reduction of cerebrovascular accidents and total health care costs.