A Real-World Study on Hypertensive People in China on the Role of Single Pill Combination (SPC) Drug Therapy

OBJECTIVES: Non adherence to anti-hypertensive medication is considered as one of the main caused factors to inadequate control of blood pressure (BP) . Numerous randomized controlled trials indicate that using single pill combination (SPC) in patients who require combination medications can improve adherence, in comparison with free-equivalent combination and single pills .This real-word study aims to prove the adherence rate of SPC and explore the correlation between adherence and patient prognosis to further explain the benefits of SPC.

METHODS: The data for this analysis were obtained from the country level data platform, which included patients aged ≥18 years who were prescribed antihypertensive drugs from 2010. The adherence rate was calculated and taken as the measure of treatment adherence. Values (<0.25, 0.25-0.75, >0.75) were considered treatment adherence low, intermediate, and high. Descriptive statistics were used to present baseline data and treatment adherence rate. Multiple regression models and Cox proportional hazards models were used to determine independent factors and calculate the correlation. P-value <0.05 was considered significant.

RESULTS: We identified 5979 patients with a diagnosis of a hypertension and only 6.4% of patients were under the age of 38. The preliminary results show that the mean difference of medication adherence for SPC vs free-equivalent combination therapies is 15.33% (95% CI 0.14-0.16) , indicating that SPC significantly improve adherence. And the improvement of adherence can delay the development of coronary heart disease (multivariable HR 0.25, 95 % CI 0.07-0.98) , diabetes (multivariable HR 0.27, 95 % CI 0.13-0.58) and stroke (multivariable HR 0.19, 95 % CI 0.08-0.48) , while other complications haven’t been found to be related.

CONCLUSIONS: The real world data has shown that BP control could be improved by better adherence, then delay or curb the occurrence of some hypertensive complications. But, in clinical practice, improving medication adherence remains a challenges.