PP.01.08] SINGLE-PILL VERSUS FREE ANTIHYPERTENSIVE COMBINATION USE BY GENERAL PRACTITIONERS IN IN BELGIUM AND LUXEMBURG

Abstract

Objective: Studies suggest that the use of single-pill combinations could improve therapeutic adherence and blood pressure (BP) control in hypertensive patients. We examined the use of single-pill or free antihypertensive drug combinations, BP control, and attitude towards prescription of single-pill combinations in current general practice. Design and method: Between January 2015 and September 2016, 742 general practitioners in Belgium and Luxemburg retrospectively collected data from 8006 consecutive hypertensive patients recently seen in their routine practice and taking at least two antihypertensive drugs. Results: Patients (mean age 67 ± 22 years [SD], 54% men, 37% with diabetes mellitus, 37% with a previous cardiovascular event) were treated with two (n = 4549), three (n = 2470) or more than three (n = 987) antihypertensive drugs. Combinations were free (n = 3089), single-pill (n = 2713) or mixed (n = 2204) (93 missing data). Blood pressure was 141/82 ± 21/11 mm Hg (mean ± SD). According to the 2013 ESH/ESC Guidelines, control rates were: systolic BP 47%, diastolic BP 70%, and both systolic and diastolic BP 42%. Estimation by the GPs of both systolic and diastolic BP control rate was 61%. Actual control rates were comparable whatever the type of combination. Blood pressure control was better in patients with low cardiovascular risk compared to patients with high risk (respectively 43% vs 33% for systolic BP control and 63% vs 47% for diastolic BP control). Patients treated with single-pill combinations were younger and had a low cardiovascular risk. In 54% (n = 4361) of the patients, physicians considered to prescribe a single-pill combination. In 1452 (18%) patients, they were willing to switch to a single-pill 2-drug combination, and in 2508 (31%) patients, they were willing to switch to a single-pill 3-drug combination. Reasons were improved adherence (71%) and better BP control (69%). Conclusions: In patients requiring at least two antihypertensive drugs, BP control rate remains low and is overestimated by GPs. Free combinations remain largely used although many GPs seem prone to switch free to single-pill combinations. Treatment simplification could improve adherence and BP control rate, which has in turn been shown to lead to reduced morbidity and mortality.