Control of HTN remains unsatisfactory in the majority of hypertensive patients, even after introduction of multidrug therapeutic strategies. Newly developed treatments based on fixed-dosed combinations (FDC) of complementary drugs are said to improve control. This study aims to compare the efficacy of FDC versus extemporaneous combinations on total mortality and cardiovascular morbidity in a real-life setting.Design and method:
Post-observational, descriptive, longitudinal, retrospective study in Primary Care of the Valencian Community, including 181.755 hypertensive patients who were treated with angiotensin 2 receptor blockers (ARB) and at least one diuretic (D) or calcium channel blockers (CCB). either on fixed-dosed combination (FDC) or extemporaneous combination, during the years 2012 and 2013.Results:
Mean age was 66,3 ± 13,2 years, the proportion of men and women was 46,8 and 53,2 %, respectively. 29,9 % of patients were initially treated with FDC, 13,2 % of the whole group switched from one to the other treatment during the study. Both strategies reduced BP, but systolic and diastolic reductions were significantly larger in the FDC group (4,3 vs. 3,5 mmHg y 2,2 vs. 1,8 mmHg, p < 0.0001), respectively, as was the proportion of controlled patients at follow-up (55,7 % vs. 55,3 %, p < 0.001). Treatment with FDC was associated with a reduced total mortality (5,3 % vs. 8,4 %, OR: 0,88; CI 0,87/0,89; p < 0.0001), a reduced incidence of stroke (3,8 % vs. 4,5 %, OR: 0,83; CI 0,79/0,87; p < 0.0001) and of ischemic heart disease (4,9 % vs. 7,9 %, OR: 0,60; CI 0,58/0,63; p < 0.0001) compared to extemporaneous treatment, not only in patients maintaining FDC during the whole study, but also in those who switched the groups.Conclusions:
Treatment with ARB in fixed-dosed combination with diuretics or calcium channel blockers are associated with higher reductions of BP, a higher proportion of controlled patients and a lower total mortality and cardiovascular morbidity.