Sicras Mainar Antoni, Muñoz Ortí Genís, Font Ramos Beatriu, Majós Oró Núria, Navarro Artieda Ruth, Ibáñez Nolla Jordi
Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, España.
Med Clin (Barc). 2013 Jul 21;141(2):53-61. doi: 10.1016/j.medcli.2012.04.026. Epub 2012 Jul 4.
To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension.
An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs.
We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001).
Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.
确定联合用药与中重度高血压患者血压控制、依从性、持续性、心血管事件（CVD）成本及发生率之间的关系。
一项观察性多中心回顾性研究。我们评估了2004年至2006年期间开始第三种抗高血压治疗的30岁以上患者。根据慢性药物数量，我们分为3组：常规服用3 - 6种药物、7 - 10种药物以及≥11种药物。主要测量指标：社会人口统计学、合并症、血压、依从性和持续性。我们确定了每组中新发CVD总数的发生率和总成本。
我们评估了1906例患者，765例服用3 - 6种药物，624例服用7 - 10种药物，517例服用≥11种药物（P <.001）。平均年龄：69.4岁，女性占55.5%。服用3 - 6种药物的组显示出更好的血压控制（51.8%对47.0%和41.1%，P <.001）、依从性（71.4%对69.9%和67.1%，P =.017）、持续性（50.1%对45.5%和46.2%，P =.044）以及更低的CVD发生率（12.2%对19.7%和30.2%，P <.001）。平均/单位总成本分别为3369.1欧元对4362.1欧元和4902.3欧元（P <.001）。CVD的存在与治疗不依从相关（比值比[OR] 1.9，95%置信区间[95%CI] 1.1至3.6），并受较低的血压控制影响（OR 1.4（95%CI 1.1 - 2.0）（P <.05）。使用固定剂量抗高血压药物具有更高的依从性（72.8%对68.2%）、持续性（64.4%对39.3%）和血压控制程度（52.6%对43.8%）（P <.001）。
联合用药与抗高血压治疗的依从性和持续性降低、心血管疾病以及医疗保健成本增加相关联。
