Improved persistence and adherence to diuretic fixed-dose combination therapy compared to diuretic monotherapy

Abstract

BackgroundDiuretics are recommended as initial treatment for hypertension. Several studies have suggested suboptimal persistence and adherence to thiazide diuretic monotherapy; this study compared patient persistence and adherence with hydrochlorothiazide (HCTZ) monotherapy to fixed-dose combinations containing HCTZ.MethodsPatients with at least one prescription claim during 2001 to 2003 for either HCTZ or one of the following fixed-dose combinations: angiotensin-receptor blockers/HCTZ (ARB/HCTZ), angiotensin-converting enzyme inhibitor/HCTZ (ACEI/HCTZ), or beta blockers/HCTZ (BB/HCTZ) were identified. Patients were required to be continuously benefit-eligible six months pre- and one year post-index date, and to have no prescription claims for any antihypertensive therapy six months prior to the index date. Patients were followed for one year to assess persistence, medication possession ratio (MPR), adherence (MPR >80%), and proportion of days covered (PDC) with initial antihypertensive therapy. Logistic regression was used to calculate adjusted odds ratios for persistence, adherence and PDC, adjusted for age, gender, business segment, RxRisk disease categories, average co-pay and concurrent cardiovascular-related medication utilization.ResultsThe study cohort consisted of 48,212 patients; 72.5% used HCTZ, 13.2% ACEI/HCTZ, 9.3% ARB/HCTZ, and 5.0% BB/HCTZ. Mean age was 53.7 years and 66.5% were female. A significantly lower proportion of patients using HCTZ (29.9%) remained persistent with therapy at 12 months compared with ARB/HCTZ (52.6%; OR = 0.37, CI = 0.36, 0.38), ACEI/HCTZ (51.4%; OR = 0.38, CI = 0.37, 0.39), and BB/HCTZ (51.9%; OR = 0.38, 0.37, 0.40). Similarly, PDC was lower for HCTZ patients (32.5%) as compared to ARB/HCTZ (53.7%; OR = 0.39, CI = 0.37, 0.40), ACEI/HCTZ (50.9%; OR = 0.42, CI = 0.40, 0.43), and BB/HCTZ (51.3%; OR = 0.44, CI 0.42, 0.45). MPR was also significantly lower for HCTZ patients as compared to those using fixed-dose combination therapies.ConclusionInitiating HCTZ fixed-dose combination therapy with an ACEI, ARB, or BB was associated with greater persistence and adherence as compared to HCTZ monotherapy. Further research is needed to determine the relationship between improved persistence and adherence with blood pressure control.

Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice

“…Consistent evidence has been obtained that the rate of discontinuation depends on a variety of factors [6] among which the type of drug initially prescribed plays a nonmarginal role [1][2][3][7][8][9]. That is, discontinuation is maximal when the initial monotherapy consists of a diuretic or a b-blocker and much less when other drugs (particularly, the blockers of the renin-angiotensin system) are used [1,8,[10][11][12], presumably because of their more favourable tolerance profile and reduced incidence of side effects [13,14].…”

Change of Hypertension Treatment Scheme in Outpatient Care at Specialized Cardiologic Institution, and Factors Associated With the Change of Antihypertension Therapy

“…Ассоциация приема фикси-рованных комбинаций с приверженностью к реко-мендованному лечению была продемонстрирована ранее [14].…”

The Effect of Patient Medication Adherence on the Outcome of Cardiovascular-Related Diseases

“…Versi lain ketaatan disebut sebagai parameter Days to Therapy Discontinuation, dan PDC disebut sebagai MPR, sedangkan PDC adalah proporsi pasien dalam persentase (%) yang memiliki masing-masing tingkat ketaatan untuk golongan yang dipelajari selama Jurnal Farmasi Klinik Indonesia Volume 3, Nomor 4, Desember 2014 periode pengamatan. 16 Persistence adalah durasi waktu seorang pasien bertahan dengan terapi setelah peresepan pertama kali atau the index date.…”

“…5,16 Prevalensi Ketidaktaatan Pasien Penyakit terkait kardiovaskular misalnya hipertensi umumnya tidak dapat disembuhkan tetapi sebagian besar pasien hipertensi dapat dikendalikan tekanan darahnya dengan terapi yang sesuai. Terapi yang dimaksud meliputi terapi obat maupun dengan perubahan pola hidup.…”