ArticleHypertension (Dallas, Tex. : 1979)2023
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.
Article in Hypertension (Dallas, Tex. : 1979), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 4 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Polypill Therapy is the Key to Improving Treatment Adherence in Comorbid Patients with High Cardiovascular Risk: A Systematic Review and Meta-Analysis.Current pharmaceutical design · 2026Pooled it
- Effectiveness of Single-Tablet Combination Therapy in Improving Adherence and Persistence and the Relation to Clinical and Economic Outcomes.Journal of health economics and outcomes research · 2024Pooled it
- Efficacy and safety evaluation of Allisartan Isoproxil in patients with hypertension: a meta-analysis.Frontiers in cardiovascular medicine · 2024Pooled it
- Efficacy of single-pill combination in uncontrolled essential hypertension: A systematic review and network meta-analysis.Clinical cardiology · 2023Pooled it
- Association between single-pill combination therapy use and blood pressure control in the Systolic Blood Pressure Reduction Intervention Trial: a post hoc analysis.European journal of preventive cardiology · 2026Trial
- Medication Non-Adherence in Resistant Hypertension: Detection, Drivers, and Practical Solutions.Current cardiology reports · 2026Review
- Challenges and Perspectives in Optimising the Treatment of Arterial Hypertension: Role of the Ramipril-Amlodipine-Hydrochlorothiazide Single-Pill Combination.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Review
- ADHD and adherence to antihypertensive medication treatment: a multinational cohort study.BMC medicine · 2026Article
- Personalizing prevention for healthy cardiovascular aging: Geriatric cardiology in the 2024-2025 hypertension and dyslipidemia guidelines.American journal of preventive cardiology · 2026Article
- Fixed-dose combination antihypertensive therapy and healthcare utilization in U.S. adults with hypertension: a propensity score-based analysis of a nationally representative population.Frontiers in pharmacology · 2026Article
- Uncontrolled Hypertension in Cardio-Renal-Metabolic Diseases: Real-World Insights on Patient Profiles and Management Patterns From iCaReMe Global Registry.International journal of hypertension · 2026Article
- Therapeutic Adherence in Cardiovascular Diseases: Insights from the Patient and Physician-A Narrative Review.Advances in therapy · 2026Review
- 2024 Thai guidelines on the treatment of hypertension.Asian biomedicine : research, reviews and news · 2025Article
- [Adherence, single pill and outcomes-What is confirmed and what does the reality look like?]Innere Medizin (Heidelberg, Germany) · 2025Review
- Frequency of Antihypertensive Drug Classes and Single-Pill Combinations in Obese Patients: An 8-Year Retrospective Study.Journal of clinical hypertension (Greenwich, Conn.) · 2025Article
- Treating hypertension with single pill combinations: a simple strategy to save costs for the patients and payers.Journal of hypertension · 2025Article
- Novel pharmacological approaches to lowering blood pressure and managing hypertension.Nature reviews. Cardiology · 2025Review
- Adherence, Persistence, and Blood Pressure Control in Hypertensive Patients: A Cross-Sectional Study in Mureș County, Romania.Medical sciences (Basel, Switzerland) · 2025Article
- Effect of single-pill versus free equivalent combinations on persistence and major adverse cardiovascular events in hypertension: a real-world analysis.Journal of hypertension · 2025Observational
- Article
Corrections and comments
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Authors and funding
10 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSingle-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality.
methodsThis was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios.
resultsAfter propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality, a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations.
conclusionsAntihypertensive combination therapy reduces all-cause mortality and cardiovascular events when provided as single pill compared to identical drugs as multipills. This strongly supports the European Society of Cardiology/European Society of Hypertension and International Society of Hypertension guidelines recommending the use of a single-pill combination and thus should be more rigorously implemented into daily clinical practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.