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REFLECTIONS
Hypertension
Hypertension Global Newsletter #5 2023

ADHERENCE Hypertension

Improved persistence to medication, decreased cardiovascular events and
reduced all-cause mortality in hypertensive patients with use of single-pill
combinations: Results From the START-Study.
Schmieder RE, et al. Hypertension. 2023 May;80(5):1127-1135.

Single-pill combination (SPC) improves adherence and persistence to medication for patients with hypertension. This retrospective
claims data (German AOK PLUS) analysis aimed to analyze whether SPC is superior to identical multiple pills combinations (MPC) in
terms of persistence to medication, for CV outcomes and all-cause mortality.

A total of 57,998 patients who were receiving renin-angiotensin system combinations either as SPC or MPC were analyzed, including
10,801 who received valsartan/amlodipine (VAL/AMLO), 1026 candesartan/amlodipine (CAN/AMLO), 15,349 ramipril/amlodipine
(RAM/AMLO), and 1823 amlodipine/valsartan/hydrochlorothiazide (VAL/AMLO/HCTZ).

Across all groups, the authors found that SPC significantly reduced all-cause mortality, along with significant reductions for CV
events such as MI, CAD, HF, stroke and TIA, for many of the combinations as SPC compared to MPC.

The hazard ratio for the composite of all-
cause hospitalization and all-cause death
was also significantly in favour of SPC
compared to MPC.

Unsurprisingly, persistence to treatment
(assessed based on prescribed/collected
defined daily doses during follow-up, with
persistence defined as maintenance >60
days) was significantly higher for SPC than
MPC for all treatment groups.

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