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REFLECTIONS
Hypertension
Hypertension Global Newsletter #6 2024

Following propensity score matching (PSM) to reduce
selection bias, the single-pill cohort included 12,150 patients, Hypertension
and the multiple-pill cohort included 6,105.

Adherence was defined as the proportion of days covered
(PDC): Non-adherence, <40%; partial adherence, 40–79%;
and adherence, ≥80%.

There was a significantly higher percentage of adherent
patients (PDC ≥80%) in the SPC compared with the multiple-
pill combination cohort (59.9% single-pill vs. 26.9% multiple-
pill, P<0.001). In contrast, there were significantly more non-
adherent patients (PDC <40%) in the multi-pill combination
cohort compared to the SPC (53.0% vs. 20.8%, respectively;
P <0.001).

After the first year of follow-up, the mortality rate was lower
in the single-pill cohort (29.9 per 1000-person/year, mean
follow-up 1.6 ± 0.9 years) vs. multiple-pill cohort (33.7 per
1000-person/year, mean follow-up 3.3 ± 2.3 years) (P<0.05).
Similarly, a lower incidence of death and CV events as
a composite end point was seen in patients who were
prescribed SPC, 105.8 per 1000-person/year (mean follow-up
1.6 ± 0.9 years) compared with 139.0 per 1000-person/year
(mean follow-up 3.0 ± 2.2 years) (P<0.001) for patients on
multiple pills.

Finally, average annual direct healthcare costs were lower
in the SPC cohort (€2970) compared to the multi-pill cohort
(€3642) (P <0.05), which is largely driven by the costs of all-
cause hospitalisations and the cost of all drugs.

The authors conclude that this real-world study of patients with hypertension demonstrates the multiple benefits of triple SPC for
patients and funders by reducing pill burden, mortality, and costs.

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