Does a Combination Pill of Antihypertensive Drugs Improve Medication Adherence in Japanese?

Matsumura, Kiyoshi; Arima, Hisatomi; Tominaga, Mitsuhiro; Ohtsubo, Toshio; Sasaguri, Toshiyuki; Fujii, Koji; Fukuhara, Mikio; Uezono, Keiko; Morinaga, Yuki; Ohta, Yuko; Otonari, Takatoshi; Kawasaki, Junya; Kato, Isao; Tsuchihashi, Takuya

doi:10.1253/circj.cj-11-1481

Cited by 26 publications

(17 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A high-dose BID regimen of ARBs is an effective approach for early-morning and evening control of BP and treatment-resistant hypertension in CKD patients with increased renin-angiotensin-aldosterone system activity. Nonetheless, a reduction in the number of daily tablets and the dosing frequency may improve treatment compliance [12][13][14] in CKD patients with hypertension requiring long-term continuous therapy, potentially improving the therapeutic effect in these patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of once daily versus twice daily olmesartan in patients with chronic kidney disease

Sakai¹,

Suzuki²,

Mugishima³

et al. 2013

IJNRD

View full text Add to dashboard Cite

Background:The effects of olmesartan (OLM) on blood pressure and kidney function in Japanese patients with chronic kidney disease (CKD) were compared between 20 mg twice daily (BID) and 40 mg once daily (QD) treatments. Methods: The subjects were Japanese CKD patients with concurrent hypertension who had been treated with OLM 20 mg BID for at least 3 months on an outpatient basis (n=39). After a change in the treatment regimen to 40 mg OLM QD (after breakfast), blood pressure (BP) (n=39), morning home BP (n=13), estimated glomerular filtration rate (n=39), and urinary albumin-to-creatinine ratio (n=17) were monitored for 2 months. Results: No significant change in office (mean ± standard deviation [SD] [mmHg], 143.9 ± 18.8/75.7 ± 12.0 to 141.6 ± 16.1/74.7 ± 11.7, not significant [ns]) or early morning home (mean ± SD [mmHg], 133.8 ± 15.9/71.2 ± 11.5 to 133.8 ± 13.9/74.5 ± 10.5, ns) BP was observed 2 months after the change in dose. The estimated glomerular filtration rate increased significantly (mean ± SD, 49.0 ± 28.0 to 51.8 ± 27.0, P,0.05), whereas urinary albumin-to-creatinine ratio did not change significantly (mean ± SD, 0.551 ± 0.445 to 0.364 ± 0.5194, ns). Conclusion: High-dose OLM administered BID and QD had similar effects on outpatient and early morning home BP in CKD patients, suggesting that the BID regimen can be safely changed to a QD regimen. For CKD patients with hypertension requiring continuous long-term treatment, the possibility that the QD regimen might bring a greater therapeutic effect was suggested. However, recognizing the best blood pressure control level for a CKD patient is still a matter of debate, and should ideally be personalized.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of once daily versus twice daily olmesartan in patients with chronic kidney disease

Sakai¹,

Suzuki²,

Mugishima³

et al. 2013

IJNRD

View full text Add to dashboard Cite

show abstract

“…One recently published randomized, controlled trial, in which the average adherence was 98%, showed that treatment with antihypertensive SPCs resulted in a similar adherence in contrast to equivalent free combinations during the 6-month period. 27 However, switching free-combination antihypertensive drugs to the equivalent SPCs could worsen medication adherence in adequate adherers is demonstrated for the first time in this study. The possible explanations include, first, patients who regularly refilled their prescriptions of 2 free-combined antihypertensive drugs may not take both of their antihypertensive medications as the doses prescribed and at the same time.…”

mentioning

confidence: 63%

Bidirectional Adherence Changes and Associated Factors in Patients Switched From Free Combinations to Equivalent Single-Pill Combinations of Antihypertensive Drugs

Wang

Chen

et al. 2014

Hypertension

View full text Add to dashboard Cite

958T he complexity of blood pressure regulatory mechanisms suggests that combined use of antihypertensive drugs with different pharmacological actions to achieve synergism is a rational approach to obtain optimal control of hypertension.1 Recent hypertension guidelines also recommend initiating antihypertensive therapy with 2 drugs if blood pressure is >20 mm Hg above systolic goal or >10 mm Hg above diastolic goal. 2,3 In most countries, more than half of treated patients with hypertension are indeed on ≥2 drugs. 2,4 Moreover, patients with hypertension are often associated with other cardiovascular risk factors and comorbidities, which may further increase the pill burden. Therefore, polypharmacy and resultant noncompliance are both frequently encountered problems in the management of hypertension. 5To simplify complex medical regimens and improve adherence, the use of combinations of ≥2 antihypertensive drugs at fixed doses in a single tablet, commonly called fixed-dose combinations or single-pill combinations (SPCs), has been advocated in several hypertension guidelines. 2,3,6,7 In a recent meta-analysis of studies comparing the administration of antihypertensive SPCs with their corresponding free-drug combinations, the compliance rate was improved by 21% in patients receiving SPCs. 8 However, most evidences showing that SPCs were associated with improved adherence are from cohort studies with parallel group comparisons and without adjustments for comorbidities and concomitant medications. The only relevant randomized crossover studies were of small size and conducted ≈3 decades ago.9,10 In other words, there are no reported studies assessing the effects of SPCs on adherence in real-world patients with hypertension switched from free-drug combinations to SPCs. Given that SPCs have also been accused of reduced flexibility in dosing and possible increased adverse effects, it is of importance to examine whether the common practice of switching from free-drug combinations to SPCs does invariably achieve better adherence in diverse patients with hypertension.The computerized claims database of the National Health Insurance (NHI) in Taiwan provides us a unique opportunity to carry out such a study. In this study, we aimed to assess (1) the effect of switching from antihypertensive free-drug Abstract-There are no reported studies assessing the effects of fixed-dose single-pill combinations (SPCs) of antihypertensive drugs on adherence in real-world patients with hypertension switched from free combinations to the corresponding SPCs. In this retrospective cohort study with a 1-year mirror-image design, a total of 896 patients who had been prescribed with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and a thiazide-type diuretic within the preceding 12 months of the index (switching) date and the corresponding SPC within 12 months after the index date were included by using the Taiwan National Health Insurance database from January 2001 to December 2007. Adherence was measured by medicati...

show abstract

“…13 of the 21 studies (62%) showed a positive effect of the intervention under study on adherence compared with a control group (Table 1a, b) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25); eight studies did not (Table 1c, eTable) (26)(27)(28)(29)(30)(31)(32)(33). In 12 of the 13 studies showing a positive effect on adherence, at least one end point regarding antihypertensive therapy improved (Table 1a), in one study this was not the case (21).…”

Section: Resultsmentioning

confidence: 99%

“…The calculated statistical power regarding the adherence end point was not reached, because the number of included patients was notably below the intended number (111 and 112, instead of two groups of 250 each). In another study, adherence at baseline was as high as 98%, blood pressure regulation was initially also already good, at <140/80 mm Hg (29). Even if an improvement in adherence could have been noted in this setting it is highly questionable whether this would have sufficed for a clinically relevant effect on blood pressure.…”

Section: Type Of Intervention/case Numbers (Control Vs Intervention)mentioning

confidence: 95%

Improving Adherence With Medication

Matthes

Albus²

2014

Deutsches Ärzteblatt International

View full text Add to dashboard Cite

The promotion of adherence to prescribed medication is clearly desirable. Studies on the treatment of hypertension have shown that attempts to improve adherence often fail. In most studies, however, improved adherence led to better clinical outcomes. Simplification of drug regimens (e.g., reducing the number of pills taken per day) is the single most effective way to promote adherence. Moreover, the findings of studies on the treatment of hypertension and other diseases suggest that shared decision-making should be the basis of physicianpatient discussions about medication. Suitable medications can also be chosen in order to maximize safety and efficacy even if adherence is incomplete. It would also be desirable for studies on the promotion of adherence to be carried out in Germany, under the specific conditions that prevail in our national health-care system.

show abstract

Does a Combination Pill of Antihypertensive Drugs Improve Medication Adherence in Japanese?

Cited by 26 publications

References 23 publications

Comparison of once daily versus twice daily olmesartan in patients with chronic kidney disease

Comparison of once daily versus twice daily olmesartan in patients with chronic kidney disease

Bidirectional Adherence Changes and Associated Factors in Patients Switched From Free Combinations to Equivalent Single-Pill Combinations of Antihypertensive Drugs

Improving Adherence With Medication

Contact Info

Product

Resources

About