POLYPILL STRATEGY REVEALS A HIDDEN ADHERENCE–RISK SIGNAL IN HIGH-RISK HYPERTENSION

Objective: To evaluate the association between medication adherence, assessed by the Scale (MMAS-8), and SCORE2-estimated cardiovascular risk after 6 months of treatment with a polypill strategy compared to a free combination regimen in high and very-high-risk hypertensive patients Design and method: The study included 119 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 and average score of MMAS-8 was 1.6±.1.5 score. 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 = 59): separate administration (perindopril/amlodipine and rosuvastatin). Treatment adherence and CV risk was evaluated before and after 6 month therapy using the MMAS-8 questionnaire and Fatal and nonfatal cardiovascular risk evaluated by SCORE2 scale. 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: After 6 months of therapy, a strong and statistically significant inverse correlation was observed between MMAS-8 scores and SCORE2-estimated cardiovascular risk in the polypill group (rs = - 0.83266, p < 0.001), indicating that higher medication adherence was associated with a markedly lower cardiovascular risk. In contrast, no significant correlation was identified in the free combination group (rs= - 0.06146, p = 0.65272). These findings suggest that the polypill strategy enhances the link between improved adherence and cardiovascular risk reduction Conclusions: A fixed-dose polypill strategy combining antihypertensive and lipid-lowering agents is associated with a strong inverse relationship between medication adherence and SCORE2 cardiovascular risk. Unlike free combination therapy, the polypill approach appears to optimize adherence-related cardiovascular risk reduction, supporting its use as an effective strategy in high-risk hypertensive patients

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