The impact of fixed‐dose combination versus free‐equivalent combination therapies on adherence for hypertension: a meta‐analysis

Abstract

Nonadherence to antihypertensive medication is considered as a reason of inadequate control of blood pressure. This meta-analysis aimed to systemically evaluate the impact of fixed-dose combination (FDC) therapy on hypertensive medication adherence compared with free-equivalent combination therapies. Articles were retrieved from MEDLINE and Embase databases using a combination of terms "fixed-dose combinations" and "adherence or compliance or persistence" and "hypertension or antihypertensive" from January 2000 to June 2017 without any language restriction. A meta-analysis was performed to parallel compare the impact of FDC vs free-equivalent combination on medicine adherence or persistence. Studies were independently reviewed by two investigators. Data from eligible studies were extracted and a meta-analysis was performed using R version 3.1.0 software. A total of nine studies scored as six of nine to eight of nine for Newcastle-Ottawa rating with 62 481 patients with hypertension were finally included for analysis. Results showed that the mean difference of medication adherence for FDC vs free-equivalent combination therapies was 14.92% (95% confidence interval, 7.38%-22.46%). Patients in FDC group were more likely to persist with their antihypertensive treatment, with a risk ratio of 1.84 (95% confidence interval, 1.00-3.39). This meta-analysis confirmed that FDC therapy, compared with free-equivalent combinations, was associated with better medication adherence or persistence for patients with hypertension. It can be reasonable for physicians, pharmacists, and policy makers to facilitate the use of FDCs for patients who need to take two or more antihypertensive drugs.

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

“…More prospective studies are needed to clearly define the benefits of FDCs. Moreover, this meta‐analysis did not evaluate whether different types of FDCs (eg, renin‐angiotensin system inhibitors combined with diuretics vs renin‐angiotensin system inhibitors combined with calcium channel blockers) have the same impact on adherence . It appears that adherence to diuretics is lower than with other antihypertensive agents .…”

“…In this context, a meta‐analysis by Du and colleagues offers valuable information in the effort to improve adherence to antihypertensive treatment. The authors analyzed nine studies in 62 481 patients with hypertension and report that the mean difference of medication adherence for fixed‐dose combination (FDC) vs free‐equivalent combination therapies was 14.92% (95% confidence interval, 7.38%–22.46%) . Moreover, patients in the FDC group were nearly two times more likely to adhere to their antihypertensive treatment (risk ratio, 1.84, 95% confidence interval, 1.00–3.39) …”

“…Despite the important findings reported in this meta‐analysis, there are still unanswered questions regarding the role of FDCs in the management of hypertension. First, eight of nine studies included in the meta‐analysis by Du and coworkers were retrospective. More prospective studies are needed to clearly define the benefits of FDCs.…”

A new strategy for taste masking on bitter drug by other combined drug in fixed-dose combination: bitterness of Amlodipine besylate could be masked efficiently by Valsartan

“…[1,2] However, such complex drug therapy regimes may result in poor adherence. A combination product, which includes two or more active pharmaceutical ingredients (APIs) combined in a single dosage form, a socalled a fixed-dose combination (FDC), [3][4][5][6][7][8][9] will improve patient adherence [10,11] and thus maximize the benefits of antihypertensive therapy.…”

“…Chemical shifts of each proton for AML with or without TEL (a), VAL (b) obtained using 1 H-NMR in DMSO-d6 …”