OBJECTIVES: To evaluate the risk of cardiovascular specific hospitalizations with different types of antihypertensive triple combination therapy among patients enrolled in a MAP.

METHODS:A retrospective cohort study was conducted among older adult patients with hypertension enrolled in Texas MAP between January 2014 and December 2016. Antihypertensive combination therapy users were classified into single pill triple combination group, fixed dose dual combination plus a third agent group, and free triple combination group. The primary outcome of interest was time to first cardiovascular related hospitalization. Descriptive statistics with patient characteristics were examined. Group differences were assessed using chi-square tests for binary variables and student’s t-tests for continuous variables. Cox proportional hazards model was performed to assess the association between type of combination therapy and risk of cardiovascular specific hospitalization adjusting for potential confounders including demographic variables, adherence, CMS risk score and several comorbidities.

RESULTS:A total of 10,836 triple combination users were identified with 336 (3.10%) patients in the single pill triple combination group, 470 (4.34%) patients in the fixed dose dual combination plus a third agent group and 10,030 (92.56%) patients in the free triple combination group. The risk of CVD hospitalization for the fixed dose dual combination plus a third agent group was significantly higher than the single pill triple combination group (HR: 3.82, 95%CI: 1.80-8.12). In addition, the risk of CVD hospitalization for the free triple combination therapy group was significantly higher than the single pill triple combination group (HR: 3.65, 95% CI: 1.43-9.31). Male patients, higher CMS risk score, and comorbidities such as depression, diabetes, heart failure, and neuropathy were significantly associated with an increased risk of CVD hospitalization.

CONCLUSIONS:Single pill triple combination therapy was significantly associated with a lower risk of CVD hospitalizations in comparison to other types of triple combination therapy.