Improving Drug Adherence Using Fixed Combinations Caused Beneficial Treatment Outcomes and Decreased Health-Care Costs in Patients with Hypertension

Abstract

We enrolled 196 patients with hypertension who were already being treated with free-drug combinations of angiotensin-II receptor blocker (ARB) and amlodipine. The free-drug combinations of ARB and amlodipine were replaced with the same dose of the fixed-dose combinations. The average home blood pressure (BP) in all patients receiving fixed-dose combinations was significantly lower than those receiving free-drug combinations (131 ± 10/75 ± 8 vs. 136 ± 11/77 ± 9 mm Hg, P < .01) accompanied with increasing drug adherence. After lowering BP by fixed-dose combinations, the costs for medications decreased by 31% over the 3 months.

Adherence and Health Care Costs with Single-Pill Fixed-Dose Combinations in Hypertension Management

“…45 Adherence was significantly greater and morning mean BP significantly lower during the single-pill phase of the trial, with improvement in BP control during this phase directly related to the increase in adherence. 45 Likewise, multivariate-adjusted analysis of NHANES data from 2005 to 2010 found that single-pill combination therapy was 55% (95% CI: 20%-100%) more effective than monotherapy in achieving JNC 7 BP goals, whereas multiple-pill therapy was only 26% (95% CI: 3%-55%) more effective than monotherapy in achieving these goals. 5 In another analysis of the latest NHANES data (2009 to 2010), patients with hypertension who received single-pill combination therapy were 9.5% more likely to achieve JNC 7 BP goal than patients with hypertension who received multiple-pill therapy (68.8% vs. 59.3%, respectively).…”

“…5 In a prospective, one-way, crossover evaluation, 196 patients with hypertension were treated using dose-equivalent multiple-pill and single-pill combination therapy for consecutive 3-month periods. 45 Adherence was assessed using tablet counts, and efficacy was assessed using daily morning mean BP during the final month of each treatment period. 45 Adherence was significantly greater and morning mean BP significantly lower during the single-pill phase of the trial, with improvement in BP control during this phase directly related to the increase in adherence.…”

“…45 Adherence was assessed using tablet counts, and efficacy was assessed using daily morning mean BP during the final month of each treatment period. 45 Adherence was significantly greater and morning mean BP significantly lower during the single-pill phase of the trial, with improvement in BP control during this phase directly related to the increase in adherence. 45 Likewise, multivariate-adjusted analysis of NHANES data from 2005 to 2010 found that single-pill combination therapy was 55% (95% CI: 20%-100%) more effective than monotherapy in achieving JNC 7 BP goals, whereas multiple-pill therapy was only 26% (95% CI: 3%-55%) more effective than monotherapy in achieving these goals.…”

“…37,38 Multiple evaluations have demonstrated that reducing pill burden and simplifying the therapeutic regimen through the use of single-pill fixed-dose combination therapy improves adherence and/or persistence. 26,[39][40][41][42][43][44][45][46] In a meta-analysis published in 2007, which included data from 4 hypertension trials, fixed-dose combina-Fixed-dose combination therapy has been shown not only to be more effective in lowering BP than either free-drug combination or monotherapy, but also to increase adherence and persistence with the antihypertensive regimen. 5,26,39,40,[42][43][44][45]48 This enhanced efficacy and persistence have been shown to reduce cardiovascular risk, with a resultant decrease in the incidence of cerebrovascular disease, coronary disease, chronic heart failure, and death.…”

“…26,[39][40][41][42][43][44][45][46] In a meta-analysis published in 2007, which included data from 4 hypertension trials, fixed-dose combina-Fixed-dose combination therapy has been shown not only to be more effective in lowering BP than either free-drug combination or monotherapy, but also to increase adherence and persistence with the antihypertensive regimen. 5,26,39,40,[42][43][44][45]48 This enhanced efficacy and persistence have been shown to reduce cardiovascular risk, with a resultant decrease in the incidence of cerebrovascular disease, coronary disease, chronic heart failure, and death. 1,30,[48][49][50][51] In a retrospective cohort evaluation of 83,267 patients with newly treated hypertension and no evidence of cardiovascular or cerebrovascular disease at initiation of therapy who were followed for up to 5.5 years, the multivariate-adjusted risk of cerebrovascular disease after at least 1 year of treatment was reduced by 22% (95% CI: 13%-30%) in patients with high adherence (≥ 80%) versus those with low adherence (< 80%).…”