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ADHERENCE, PERSISTENCE AND DEGREE OF BLOOD PRESSURE CONTROL ASSOCIATED TO INCIDENCE OF CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSION TREATED WITH FIXED COMBINATIONS: PP.5.206

Study Objective: Cardiovascular disease (CVD) is one of the first cause of morbidity and mortality in developed countries, yielding an increase in the use of health care resources. Adherence to treatment is a key factor to achieve blood pressure (BP) control, and many patients require a combined therapy. The study aimed to establish the incidence of cardiovascular events (CVE) according to adherence, persistence and BP control, comparing patients treated with single pill combinations (SPC) versus free combinations (FC) of antihypertensive drugs in a population-based study in Spain. Methods: Multicentric observational (naturalistic) study, from medical records (population data base; historical cohorts). It included patients aged 30 years or older, attending six primary care clinic and two hospitals, who initiated pharmacological treatment for hypertension during 2006. Two groups were followed: SPC (ACEi/diuretics; ARB/diuretics) and FD (ACEi + diuretics; ARB + diuretics). Main Variables: Sociodemographic, comorbidity, laboratory tests, Charlson index, adherence, persistence and BP goal achievement (according to ESH-ESC criteria). Adherence was calculated dividing number of dispensed tablets by number of prescribed tablets. Incidence of CVE was recorded. Patients were followed for two years. Statistical analysis: logistic regression, Cox proportional risk model. Statistical signification: p < 0.05. Results: 1,605 patients were recruited, 1,112 (69.3%) on SPC and 493 (30.7%) on FC, p < 0.001. Mean age: 69.4±12.2 years; women: 55.5%. Patients on FC had a higher incidence of coronary artery disease; OR=1.4 (95% CI: 1.1–2.0) and organ impairments; OR=1.5 (95% CI: 1.2–2.1), p < 0.031. Patients on SPC showed a better therapy adherence (77.6% vs. 71.9%; p < 0.001) and persistence at 24 months (62.1% [95% CI: 56.3–67.9%] versus 49.7% [95% CI: 38.5–60.9%]; p < 0.001. Optimal BP control on SPC was higher (48.9% [95% CI: 43.0–54.8%] versus 46.7% [95% CI: 35.6–57.8%]; p < 0.001). Incidence of vasculocerebral accidents on FC was 4.6% versus 2.4%; p = 0.041. Conclusions: Improving antihypertensive therapy adherence and persistence with SPC translates into a better BP control, giving way to a reduction in CVE.