[Adherence, single pill and outcomes-What is confirmed and what does the reality look like?]

Patients with hypertension or dyslipidemia and patients in cardiovascular secondary protection usually require more pharmaceuticals to achieve the target values. For some years, a combination treatment with a single pill has been recommended for arterial hypertension and for most patients even from the beginning of treatment.

The aim of this review article is to present the current recommendations and illuminate the evidence with respect to cardiovascular outcomes for single pill treatment in comparison to loose combinations.

The achievement of the target values in arterial hypertension, dyslipidemia and in secondary prevention is insufficient. Poor adherence plays a major role in this. This greatly depends on the number of pills, a simple treatment schedule and as few treatment changes as possible. For this reason, national and international scientific societies recommend an initial combination treatment when possible in a single pill. This concept is supported by a broad evidence base for an improved adherence. There are now also investigations that show significant reductions in cardiovascular outcomes, including the overall mortality, for single pill treatment in comparison to the use of the same substances in identical doses in the form of loose combinations. Simultaneously, the use of a single pill leads to a reduction of the total treatment costs due to improved adherence, a lower number of hospitalizations and a reduction of cardiovascular outcomes. The implementation of the recommended concept is insufficient as combinations are still used for the majority of patients, contrary to the guidelines and despite the availability of single pills with the selected substances and doses.

The use of single pills in cardiovascular treatment improves the adherence, reduces cardiovascular outcomes and is widely recommended by specialist societies. The improvement of the insufficient implementation in the clinical practice needs comprehensive efforts.