COMPARATIVE ASSESSMENT OF THE IMPACT OF POLYPILL THERAPY VERSUS SEPARATE DRUG ADMINISTRATION ON TREATMENT ADHERENCE AND MYOCARDIAL STRUCTURAL REMODELING

Objective: To evaluate the association between adherence to therapy (assessed by the Morisky Medication Adherence Scale, MMAS-8) and left ventricular myocardial mass (LVMM) in patients receiving a fixed-dose combination polypill (lisinopril/amlodipine/rosuvastatin) compared with separate therapy (perindopril/amlodipine and rosuvastatin) over a 6-month follow-up. Design and method: The study included 120 patients with arterial hypertension and dyslipidemia at high or very high cardiovascular risk (SCORE2: 18.12 ± 7.83). The mean age was 52.5 ± 9.6 years; the mean duration of hypertension was 8.7 ± 6.6 years. Treatment adherence was evaluated using the MMAS-8 questionnaire. LVMM was measured by transthoracic echocardiography. Patients were randomized into two treatment groups receiving dual antihypertensive therapy plus statin (ACE inhibitor + calcium channel blocker + statin): Group 1 (n = 60): fixed-dose polypill (lisinopril/amlodipine/rosuvastatin); Group 2 (n = 60): separate administration (perindopril/amlodipine and rosuvastatin). Statistical analysis was performed using standard methods of descriptive and correlation statistics. Spearman's rank correlation coefficient (rs) was applied. Statistical significance was set at p < 0.05 Results: In the polypill group, a statistically significant moderate negative correlation was observed between MMAS-8 scores and LVMM (rs = -0.5768; p =0.001), indicating a greater degree of myocardial mass regression in patients with higher adherence. In contrast, the group receiving separate therapy demonstrated no significant relationship between adherence and LVMM (rs = -0.0452; p = 0.74). The absence of correlation may reflect overall lower adherence in this group, which limits the effect of therapy on reverse left ventricular remodeling. Conclusions: Fixed-dose combination therapy with lisinopril, amlodipine, and rosuvastatin (polypill) is associated with higher medication adherence and greater regression of left ventricular myocardial mass compared with a separate treatment regimen. These findings support the clinical advantages of the polypill strategy in improving adherence, treatment efficacy, and cardioprotective effects in long-term antihypertensive and lipid-lowering therapy

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