Compliance patterns of patients treated with 2 separate antihypertensive agents versus fixed-dose combination therapy

Wanovich, Robert; Kerrish, Patrick; Gerbino, Philip P.; Shoheiber, Omar

doi:10.1016/j.amjhyper.2004.03.592

Cited by 7 publications

(7 citation statements)

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“…This led to many more discontinuations because of AEs with amlodipine monotherapy than with the combination. In addition to the added advantage of a better tolerability profile for a comparable efficacy, the administration of fixed-dose combination regimen in hypertension is associated with fewer discontinuations and better compliance than administration of two agents separately (19). Lack of discontinuation or persistence to the treatment regimen is essential for hypertension control and best clinical outcome (20).…”

Section: Proportion Of Patients (%)mentioning

confidence: 99%

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

Schrader

Salvetti

Calvo

et al. 2009

International Journal of Clinical Practice

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Aims:To demonstrate the benefit of the combination amlodipine/valsartan 5/160 mg over amlodipine 10 mg, in producing a lower incidence of peripheral oedema for a comparable mean sitting systolic blood pressure (MSSBP) reduction.Methods:After a 4-week amlodipine 5 mg run-in phase, inadequately controlled hypertension patients (aged ≥ 55 years, MSSBP ≥ 130 and ≤ 160 mmHg) were randomised to receive amlodipine/valsartan 5/160 mg or amlodipine 10 mg for 8 weeks, followed by amlodipine/valsartan 5/160 mg for 4 weeks for all patients. Primary variables were MSSBP change from baseline to week 8 and incidence of peripheral oedema reported as an AE. Resolution of peripheral oedema was assessed 4 weeks after switching patients from amlodipine 10 mg to amlodipine/ valsartan 5/160 mg.Results:At week 8, MSSBP showed greater reduction with amlodipine/valsartan 5/160 mg than amlodipine 10 mg (least square mean: −8.01 vs.−5.95 mmHg, p<0.001 for non-inferiority and p=0.002 for superiority). Systolic control, overall BP control and systolic response rate at week 8 were significantly higher with combination than amlodipine 10 mg (34 vs. 26%; 57 vs. 50%; 36.57 vs. 27.77%, respectively). Incidence of peripheral oedema was significantly lower with the combination than amlodipine 10 mg (6.6 vs. 31.1%, p<0.001). Peripheral oedema resolved in 56% patients who switched from amlodipine 10 mg to the combination, without the loss of effect on BP reduction.Conclusion:In non-responders to amlodipine 5 mg, treatment with amlodipine/valsartan 5/160 mg induced significantly less peripheral oedema than amlodipine 10 mg for similar BP reduction. Peripheral oedema resolved in > 50% patients switching from amlodipine 10 mg to the combination.

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Section: Proportion Of Patients (%)mentioning

confidence: 99%

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

Schrader

Salvetti

Calvo

et al. 2009

International Journal of Clinical Practice

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“…Another study has shown that single‐pill combination therapy with a combination of amlodipine and benazepril provides significant beneficial effects in terms of compliance compared with individual component‐based therapy with an ACE inhibitor and a dihydropyridine CCB (43). In this study, compliance improved regardless of concomitant medication use; indeed, as the number of concomitant medications increased, the compliance gap between those receiving single‐pill combination therapy and those receiving separate agents increased (Figure 3).…”

Section: Improved Compliance and Persistence With Single‐pill Combinamentioning

confidence: 99%

“…Two studies have also shown better persistence with single-pill combination therapy at 12 months than with separate two-pill regimens (Figure 4) (25,69). In one of the studies (25), the percentage of patients persisting with a single-pill combination of lisinopril ⁄ HCTZ or enalapril ⁄ HCTZ at 12 months (69% and 70% respectively) was significantly greater (p < 0.05) than the percentage of patients persisting with lisinopril and a diuretic prescribed concurrently Figure 3 Single-pill combinations improve compliance regardless of the use of concomitant medications (43) or enalapril and a diuretic prescribed concurrently (58% for both regimens). In the other study (69), patients were 2.09 times more likely to be non-compliant with two pills than with single-pill combination therapy, and nearly 1.5 times more likely to be non-persistent.…”

Section: Improved Compliance and Persistence With Single-pill Combinamentioning

confidence: 99%

“…Thus, the problems associated with a lack of achievement of BP goals are multifactorial; however, many are interrelated. For example, patient compliance with treatment is related to the convenience and simplicity of the treatment regimen as well as to the efficacy and safety of the antihypertensives prescribed (26,42–45). If the efficacy and safety of the treatment regimen could be improved alongside improvements in simplicity (resulting in increased compliance), BP targets might be more easily attainable.…”

Section: Obstacles Against Achieving Blood Pressure Goalsmentioning

confidence: 99%

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Issues in blood pressure control and the potential role of single-pill combination therapies

Burnier

Brown

Ong

et al. 2009

International Journal of Clinical Practice

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Summary Hypertension (HTN) is a major risk factor for cardiovascular mortality, yet only a small proportion of hypertensive individuals receive appropriate therapy and achieve target blood pressure (BP) values. Factors influencing the success of antihypertensive therapy include physicians’ acceptance of guideline BP targets, the efficacy and tolerability of the drug regimen, and patient compliance and persistence with therapy. It is now well recognised that most hypertensive patients require at least two antihypertensive agents to achieve their target BP. However, complicated treatment regimens are a major contributory factor to poor patient compliance. The use of combination therapy for HTN offers a number of advantages over the use of monotherapy, including improved efficacy, as drug combinations with a synergistic mechanism of action can be used. This additive effect means that lower doses of the individual components can be used, which may translate into a decreased likelihood of adverse events. The use of single‐pill combination therapy, in which two or more agents are combined in a single dosage form, offers all the benefits of free combination therapy (improved efficacy and tolerability over monotherapy) together with the added benefit of improved patient compliance because of the simplified treatment regimen. The use of single‐pill combination therapy may also be associated with cost savings compared with the use of free combinations for reasons of cheaper drug costs, fewer physician visits and fewer hospitalisations for uncontrolled HTN and cardiovascular events. Thus, the use of single‐pill combination therapy for HTN should help improve BP goal attainment through improved patient compliance, leading to reduced costs for cardiovascular‐related care.

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“…Olmesartan-amlodipine combination for hypertension inhibitor benazepril has been compared with adherence to free-dose combination therapy of the two agents in a retrospective analysis of data obtained from a pharmacy claims database in the US (Wanovich and Kerrish 2004). Patients who received 2 or more prescriptions for the fi xed-dose combination (n = 2,839) or the two components separately (n = 3,367) were identifi ed and followed up for an average of 259 days and 247 days, respectively.…”

Section: Patient Adherencementioning

confidence: 99%

Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan – amlodipine combination

Pimenta

Oparil²

2008

VHRM

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Abstract:Although the awareness and control of hypertension has increased, only 37% of hypertensive patients in the US achieve the conservative goal of Ͻ140/90 mmHg. Achieving optimal blood pressure (BP) control is the most important single issue in the management of hypertension, and in most hypertensive patients, it is diffi cult or impossible to control BP with one drug. Blocking two or more BP regulatory systems provides a more effective and more physiologic reduction in BP, and current guidelines have recommended the use of combination therapy as fi rst-line treatment, or early in the management of hypertension. Fixed combination therapy is an effi cacious, relatively safe, and may be cost-effective method of decreasing BP in most patients with essential hypertension. Similar to other combinations, fi xed-dose combination tablets containing the dihydropyridine calcium channel blocker amlodipine and the angiotensin II receptor blocker olmesartan bring together two distinct and complementary mechanisms of action, resulting in improved BP control and potential for improved target organ protection relative to either class of agent alone.

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Compliance patterns of patients treated with 2 separate antihypertensive agents versus fixed-dose combination therapy

Cited by 7 publications

References 0 publications

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

Issues in blood pressure control and the potential role of single-pill combination therapies

Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan – amlodipine combination

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Compliance patterns of patients treated with 2 separate antihypertensive agents versus fixed-dose combination therapy

Cited by 7 publications

References 0 publications

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

The combination of amlodipine/valsartan 5/160 mg produces less peripheral oedema than amlodipine 10 mg in hypertensive patients not adequately controlled with amlodipine 5 mg

Issues in blood pressure control and the potential role of single-pill combination therapies

Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan &ndash; amlodipine combination

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Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan – amlodipine combination