gms | German Medical Science

20th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

05.12. - 06.12.2013, Düsseldorf

Therapy persistence in antihypertensive treatment: the more pills the better?

Meeting Abstract

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  • corresponding author presenting/speaker Thomas Grimmsmann - Medical Review Board of the Statutory Health Insurance Funds Mecklenburg-Vorpommern, Schwerin, Germany
  • author Wolfgang Himmel - Department of General Practice, University Medical Center Göttingen, Göttingen, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 20. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Düsseldorf, 05.-06.12.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13gaa38

doi: 10.3205/13gaa38, urn:nbn:de:0183-13gaa388

Published: November 25, 2013

© 2013 Grimmsmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Many patients require more than 1 drug to manage their blood pressure. It is usually taken for granted that fixed-dose combinations improve adherence but rigorous evaluations of the potential benefit of fixed combination, especially their impact on persistence is still missing.

The aim of this study was to compare therapy persistence in hypertension management between monotherapy, single-pill combinations and combinations of drugs given separately.

Materials and Methods: We used prescription data from a German statutory health insurance to follow up patients from initiation of an antihypertensive therapy for 4 years. Therapy persistence was defined as the continued use of any antihypertensive drug irrespective of the particular drug class or medication switching. We applied 2 different interval criteria (180 and 360 days) within which a repeat prescription had to be issued to define a patient as “persistent”. In contrast to monotherapy, combination therapy comprised either a fixed (“single pill”) combination or several separate antihypertensive agents. Multiple prescriptions on the same day were accounted as one prescription. Two or more different agents prescribed at the same day for the first time was considered an initiation of an antihypertensive therapy with separate agents.

Results: A total of 9,513 patients started with a new antihypertensive treatment, 7,235 (76.1%) with a monotherapy and 2.278 (23.9%) with a combination therapy. Of the patients who started with a monotherapy, 40% (77%) were still therapy persistent after 4 years when we apply the 180 (360) days criterion for continued drug use. The rates were not or only marginally higher when we look at patients with a single-pill combination of two drugs (43% or 77%, respectively). However, many more of those patients who started with a combination of 2 different drugs were still therapy persistent after 4 years: 60% (applying the 180 days criterion) or 87% (applying the 360 days criterion). Age or gender had no or only moderate effects on the results.

Conclusion: Therapy persistence was somewhat better for patients starting with a combination of 2 different drugs, compared to those with a single-pill combination. We cannot exclude this result to be an artefact. Another explanation may be that separate drugs give patients the freedom to experiment with the single drugs, including the possibility to take both or to cancel one of them, thus providing a more responsible role of the patients as his or her own health agent.