ArticleClinical research in cardiology : official journal of the German Cardiac Society2023
Use of fixed-dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 28 citations in OpenAlex.
- Trends in Antihypertensive Medication Use and Blood Pressure Control in Adults Aged 66-79: Results of the National Examination Surveys DEGS1 and Study on Health of Older People Gesundheit 65.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Prevalence and Medical Treatment of Arterial Hypertension and Hypercholesterolemia in Germany: a Nationwide questionnaire-based Survey in Medical Practices.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Article
- [Adherence, single pill and outcomes-What is confirmed and what does the reality look like?]Innere Medizin (Heidelberg, Germany) · 2025Review
- Effect of three-drug single-pill antihypertensive combinations in patients with uncontrolled hypertension.International urology and nephrology · 2025Article
- Study of the Acidic, Basic, and Thermal Degradation Kinetics of Three Antihypertensive Drugs-Individually and in Combination.Pharmaceutics · 2024Article
- Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Review
- Reimagining Medication Adherence: A Novel Holistic Model for Hypertension Therapy.Patient preference and adherence · 2024Article
- Drug Release and Stability Study of Innovated Losartan Potassium and Rosuvastatin Calcium Fixed-dose Combination Tablet.Current pharmaceutical design · 2024Article
- Arterial Hypertension-clinical trials update 2023.Hypertension research : official journal of the Japanese Society of Hypertension · 2023Review
- [Cardiovascular pharmacotherapy in old age].Herz · 2023Article
- [The polypill in cardiovascular prevention: successful through simplification? : New study results on the benefit of the polypill strategy in primary and secondary prevention].Innere Medizin (Heidelberg, Germany) · 2023Review
- Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study.Hypertension (Dallas, Tex. : 1979) · 2023Article
- The Impact of International Nonproprietary Names Integration on Prescribing Reimbursement Medicines for Arterial Hypertension and Analysis of Medication Errors in Latvia.International journal of environmental research and public health · 2022Article
- Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012-2021.Frontiers in cardiovascular medicine · 2022Article
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines for the management of hypertension highlight the importance of fixed-dose combinations (FDC) for the treatment of hypertension and recommend initial single-pill combination therapy in almost all patients. However, data on the implementation of these recommendations in clinical practice are scarce.
methodsData from the German Institute for Drug Use Evaluation (DAPI) were analyzed and extrapolated accounting for approximately 88% of Germany's population (approximately 73.3 million subjects). All antihypertensive (AHT) FDC products available on the German market were included in the analyses. We examined the time course of dispensed packages between January 2016 and December 2020.
resultsFDCs accounted for 15.4% of all AHT in 2016 and for 10.9% in 2020. While dispensing of all AHT increased slightly from year to year (2016: 143.8 million, 2020: 153.2 million packs), dispensing of FDCs decreased from 22.2 million (2016) to 16.6 million (2020) packs. Dispensing of FDCs containing hydrochlorothiazide (HCT) declined considerably from 2016 to 2020 (Q1 2016: 4.65 million, Q4 2020: 3.13 million packs). Accordingly, the proportion of HCT-containing combinations in all FDCs decreased from 85.3 to 74.2% from Q1 2016 to Q4 2020. Patients younger than 80 years were prescribed FDCs more frequently (14.6% of all AHT, based on the entire evaluation period) than patients 80 years and older (10.0%). In both age groups, this proportion decreased continuously over time.
conclusionsAlmost 2 years following the release of the 2018 ESC/ESH guidelines, only 10.9% of the prescribed packs of antihypertensive drugs in 2020 were FDC products, documenting underutilization of current guideline recommendations on pharmacotherapy in hypertension. Structured programs to evidence-based decision support are required to improve guideline inertia and patient outcomes, eventually.
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