Free or Fixed Combination – Finding a Good Start in Hypertension Treatment

DOI: 10.3238/zfa.2018.0449-0453

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Linda Sanftenberg, Florian Niederbuchner, Christian Leistner, Jörg Schelling

Keywords: arterial hypertension combination therapy family practitioner first-line therapy fixed therapy

Background: Arterial hypertension is a widespread disease with severe long-term effects and an important risk factor for cardiovascular events. To adjust the blood pressure values individually, combination therapies show advantages in many cases of manifest hypertension, and especially fixed combinations may simplify the treatment. But there is a high risk of stopping several antihypertensive drugs completely when fixed combinations are discontinued. Therefore we tried to identify different parameters that may influence the dropout rates in patients with hypertension.Methods: This retrospective study used a questionnaire for patients with antihypertensive drug treatment in five family physicians’ offices from 02/2015–10/2015. The questionnaire asked about tolerance of drugs, compliance and adherence, and modifications of treatment. Data used for frequency analysis and the measures of locations were evaluated via t-test (level of significance: p ≤ 0.05). Hypothesis testing was done by using 2 x 2 contingency tables; independence was controlled by chi-squared-tests. To compare different types of therapies, an adjustment according to the prescription frequency was applied. When observation numbers were too low, the exact Fisher test was used.Results: 132 patients were included in our analysis. 72.6 % of the patients received free combination therapies or monotherapies for hypertension and 27.4 % received fixed combination therapies. 71.4 % of the patients who had reported drop outs in the past, received free combination therapies or monotherapies and 10.4 % of these patients assessed themselves as adherent. 42.9 % of the patients, who had stopped their treatment in the past, reported five or more side effects. Previous therapy modifications caused a significantly higher number off drop outs (p = 0.040). Concerning first-line therapies, 56.3 % of the patients who had received a free combination of drugs or monotherapies had discontinued their drugs in the past.Conclusions: Sufficient adherence is crucial in the treatment of hypertension and can be increased by prescribing fixed combination therapies. To minimize the risk of an undesirable discontinuation of treatment, multiple side effects and unnecessary modification of treatment should be avoided. The first-line therapy should be chosen carefully. Therefore, a general recommendation is not reasonable and an individual shared decision making process seems necessary to determine the best therapy for every single patient.

(State: 19.11.2018)

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