To examine the use of free or fixed-dose antihypertensive combinations in current practice, blood pressure (BP) control, and attitude towards prescription of fixed-dose combinations.Design and method:
Between January and June 2015, 388 general practitioners retrospectively collected data from 4110 consecutive hypertensive patients recently seen in their routine practice and taking at least 2 antihypertensive drugs.Results:
Patients (mean age 67 ± 25 years [ ± SD], 55% men, 31% with diabetes mellitus, 31% with a previous cardiovascular event) were treated with 2 (n = 2302), 3 (n = 1313), or > 3 (n = 495) antihypertensive drugs. Combinations were free (n = 1577), fixed (n = 1345), or mixed (n = 1148) (missing data, n = 40). BP was 140 ± 23/82 ± 11 mmHg (mean ± SD). According to the 2013 ESH/ESC Guidelines, BP control rates were: systolic BP 49%, diastolic BP 72%, both systolic and diastolic BP 44%. According to the 2009 ESH/ESC Guidelines, systolic and diastolic BP control rate was 20%. Estimation by the GPs of systolic and diastolic BP control was 62%. Many physicians expressed the intent to prescribe fixed-dose combinations of bitherapy (in 896 patients) or of tritherapy (in 1394 patients) instead of free combinations. Reasons for this were improved adherence (73%) and better BP control (71%).Conclusions:
Free combinations remain largely used although GPs seem prone to prescribe fixed-dose combinations. In these high-risk patients requiring at least 2 antihypertensive drugs, BP control rate remains low and is overestimated by GPs. Increasing prescriptions of fixed-dose combinations could improve patient adherence and BP control.