02583nas a2200301   4500000000100000008004100001100001300042700001300055700001500068700001500083700001500098700001400113700001400127700001400141700001300155700001400168700001300182700001300195700001500208700001500223700001400238245012900252250001500381300001100396490000700407520182100414020004602235       2011                            d1 aSelak V.1 aElley C.1 aCrengle S.1 aHarwood M.1 aDoughty R.1 aArroll B.1 aBryant L.1 aRafter N.1 aHoorn S.1 aWadham A.1 aWells S.1 aMilne R.1 aJackson R.1 aBramley D.1 aRodgers A00aIMProving Adherence using Combination Therapy (IMPACT): design and protocol of a randomised controlled trial in primary care  a2011/07/23  a909-150 v323 a<p>
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death, and principal reason for the large difference in life expectancy between indigenous Maori and the non-indigenous population in New Zealand. CVD guidelines recommend that people who are at high risk or who have had previous CVD should be offered aspirin, blood pressure lowering and lipid lowering therapies. However, prescribing and adherence rates are low and CVD events remain high. AIM: To assess whether a medication strategy using a fixed dose combination pill ('polypill') could improve prescribing and adherence to recommended medications, lower blood pressure and improve lipids compared with current care over 12 months. METHODS: IMProving Adherence using Combination Therapy (IMPACT) is an open-label randomised controlled trial comparing a once-daily polypill containing four preventive medications with usual care. Six hundred participants who have had previous CVD events or are at high risk of CVD will be enrolled, including 300 Maori. Participants are identified, enrolled and prescribed either the polypill or current medications at their usual primary health care practice, with medications (including the polypill) dispensed through local community pharmacies. The polypill contains 75 mg aspirin, 40 mg simvastatin, 10mg lisinopril and either 12.5mg hydrochlorothiazide or 50mg atenolol. Primary outcomes are adherence to guidelines-recommended medications and changes in systolic blood pressure and low density lipoprotein at 12 months. Secondary outcomes include other lipids, medication dispensing, barriers to adherence, CVD and other serious adverse events, quality of life and prescriber acceptability. The trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12606000067572).
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