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Author: Admin | 2025-04-28
To the three-drug two-pill combination, patients under three-drug SPC had a much lower risk of treatment discontinuation (41%, 40–43%, P FIGURE 3: Risk ratios (RR), and 95% confidence intervals (CI), estimating the association between treatment discontinuation and single-pill combination vs. the two-pill combination. Three categories were considered for the clinical profile according to the Multisource Comorbidity Score (MCS): good (0 ≤ MCS≤4), intermediate (5 ≤ MCS ≤ 14), and poor (MCS ≥ 15).Adherence to antihypertensive treatment and clinical outcomes The cohort members accumulated 105 465 person-years of observation (on average, 1.9 years per patient) and generated 2441 CV hospitalizations. There were 207 outcomes every 10 000 person-years among patients on SPC, and 246 outcomes every 10 000 person-years among those under the three drug two-pill combination. According to the summarized estimates, in the whole study population there was a progressive reduction in the adjusted risk of hospitalization as adherence increased from very low to high levels (Fig. 4). Compared with very low adherence, patients with intermediate and high adherence showed an adjusted risk reduction of 8% (0–15%) and 26% (20–32%), respectively. There was no evidence that these risk reductions differed between treatment strategy groups (P-value = 0.066 and 0.923, respectively) (Figure S1, Supplemental Digital Content, https://links.lww.com/HJH/C217).FIGURE 4: Hazard ratios (HR), and 95% confidence intervals (CI), for cardiovascular hospitalization associated with adherence to antihypertensive drugs, after adjustment for the baseline characteristics. Meta-analytic procedures were used for summarized estimates. Adherence categories are: very low (PDC 75).Healthcare costs The mean healthcare cost was € 721 among patients under three-drug SPC and €811 under three-drug two-pill combination (Table S2, Supplemental Digital Content, https://links.lww.com/HJH/C217). According to the linear model, three-drug SPC users had €64 lower costs for CV healthcare services (P Sensitivity analyses As shown in Tables S3–S5, Supplemental Digital Content, https://links.lww.com/HJH/C217, the results described in the previous sections did not change by modifying the PDC categorization, extending the follow-up during which adherence was measured to two years, or by adopting the propensity score matching design. As shown in Figure S2, Supplemental Digital Content, https://links.lww.com/HJH/C217, patients on three-drug two-pill combination should have halved the daily dose to nullify the observed between-group difference in treatment adherence. DISCUSSION Our study provides a number of novel findings. First, the chance of being highly adherent to the triple combination of antihypertensive drugs was significantly greater in patients on the three-drug SPC than in those prescribed the same three drug classes in a two-pill combination. Second, compared to the three-drug two-pill combination, the three-drug SPC strategy reduced the risk of patients to be poorly adherent to the treatment regimen as well as to discontinue the three prescribed drugs. Third, the benefits of the three-drug SPC strategy were shared by males
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