Impact of a Better Adherence to Antihypertensive Agents on Cerebrovascular Disease for Primary Prevention

Kettani, Fatima-Zohra; Dragomir, Alice; Côté, Robert; Roy, Louise; Berard, Aurélie; Blais, Lucie; Lalonde, Lyne; Moreau, Pierre; Perreault, Sylvie

doi:10.1161/strokeaha.108.522193

Cited by 132 publications

(99 citation statements)

References 26 publications

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“…The impact of adherence to hypertensive treatment on health care resources utilisation and/or health outcomes were confirmed by observational studies [23,24] as well as simulation studies [30,31].…”

Section: Discussionmentioning

confidence: 79%

“…Available information indicating the impact of SPC treatment on the risk of CVD events [6,7] or indicating a difference in that risk between patients adherent and non-adherent to hypertensive treatment [23,24] applies only to specific groups of patients and cannot be generalised to the total population of patients with arterial hypertension. We used SBP as the only predictor of different health outcomes between patients treated with SPCs and FCs mainly because results of the Framingham Heart Study, which indicated a higher prediction capability of this measure than diastolic blood pressure when assessing both as a continuous variables [14], and to create a framework for the assessment of SPCs in specific subgroups of patients with arterial hypertension (the algorithms used in our study could be easily incorporated in future simulations that could assess the value of SPCs in subgroups of patients).…”

Section: Determinants Of Effectivenessmentioning

confidence: 99%

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Economic evaluation of single-pill combination of indapamide and amlodipine in the treatment of arterial hypertension in the Polish setting

Kawalec

Holko²,

Stawowczyk³

et al. 2015

Kardiol Pol

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A b s t r a c tBackground: Arterial hypertension is a common disorder that affects around 9 million adults in Poland. Single-pill combinations (SPCs) for the treatment of arterial hypertension have significant advantages over the free combinations, resulting in lower risk of cardiovascular events and lower consumption of medical resources. The current ESC/ESH 2013 guidelines for the first time recommend treatment with a combination of thiazide-like diuretic with calcium channel blocker. Currently, no such combination is reimbursed from public funds in Poland. Aim:To assess the economic value of treatment with SPC of indapamide and amlodipine (Tertens-AM ® ) for hypertensive patients compared with free combination therapy (FC), in the Polish setting. Methods:As there are currently no published data directly estimating the additional effect of using indapamide + amlodipine SPC vs. FC, two extreme approaches are presented: with difference in effectiveness due to improved adherence to the treatment estimated from published studies on other molecules used in hypertension such as SPCs and FCs -the base-case approach (1); and assuming no difference of effectiveness or adherence between SPC and FC of indapamide and amlodipine -the conservative approach (2). Modelling was carried out based on the Markov process in lifetime horizon. In the base-case approach, with the difference in effectiveness between SPC and FC, it was assumed that the differences in compliance translate into the differences in systolic blood pressure. Patients' characteristics were correlated with the risk of events associated with cardiovascular disease, based on the prediction algorithms from the Framingham Heart Study. Costs were considered from a National Health Fund (NHF) perspective and NHF and patient's perspective, and therefore direct medical costs were only included. Results:The treatment with SPC of indapamide and amlodipine in place of FC resulted in 7.6 additional days of life in full health and longer overall patient survival by 2.9 days. The replacement of FC with SPC would result in national savings from both NHF perspective and NHF and patient's perspective, irrespective of the assumption of the difference in adherence between SPC and FC. The savings would amount to 1.602-3.954 million .186 million PLN from NHF perspective and NHF and patient's perspective, respectively. Conclusions:The treatment with SPC of indapamide and amlodipine for hypertensive patients was found to be dominant over FC or at least less expensive than treatment with FC when the difference in effectiveness was neglected. The replacement of FC with SPC would result in savings from both NHF perspective and NHF and patient's perspective.

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Section: Discussionmentioning

confidence: 79%

Section: Determinants Of Effectivenessmentioning

confidence: 99%

Economic evaluation of single-pill combination of indapamide and amlodipine in the treatment of arterial hypertension in the Polish setting

Kawalec

Holko²,

Stawowczyk³

et al. 2015

Kardiol Pol

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“…Existing publication focus generally on single cohort of patients [8,16,[18][19][20][21]. We have chosen to compare different cohorts of hypertensive patients managed in the same geographical, clinical and organizational setting in order to have a comprehensive evaluation of the real world.…”

Section: Discussionmentioning

confidence: 99%

“…Subjects were grouped into 4 adherence categories as follows: PDC ≤ 40%, ranging from 41% to 60%, ranging from 61% to 80%, and PDC > 80%. When PDC was ≤20%, indication for AHD was considered uncertain or questionable and, therefore, the corresponding subjects were excluded [16].…”

Section: Adherence To Ahtmentioning

confidence: 99%

Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients

Esposti¹,

Saragoni²,

Veronesi³

et al. 2013

Health

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and older (66.4 ± 11.6, 67.5 ± 13.2 VS 61.6 ± 13.9) than hypertensive patients and were more treated with concomitant therapy. Drugs acting on the renin-angiotensin system were the more frequent choice in the three cohorts but with a different prevalence (63.9%, 52.9%, 35.9% in diabetic, hypertensive and high risk patients respectively). Adherent patients to AHD (PDC > 80%) were 44.0% among diabetic patients, 48.4% among high risk, 35.2% among hypertensive. A Cox regression model showed that the risk of the combined outcome was determined by increasing age, male gender, presence of concomitant therapy, low adherence to AHD and first choice of AHD. Conclusions: An integrated analysis of prescription and hospital discharge database has the great advantage that it uses routinely available data, it can be done quickly and by few staff, and it is less expensive than planned large scale survey.

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“…15 A Canadian study reported a 22% reduction in stroke incidence in patients with high adherence (medication possession ratio $80%) compared with patients with lower adherence in a cohort of 83,267 newly treated hypertensive patients. 22 More recently, an Italian populationbased prospective cohort study of 242,594 patients showed a significant increase in the incidence in coronary and cerebrovascular events in patients who discontinued treatment and in patients with low drug coverage, after a mean follow-up of 6 years. 23 The impact of adherence on blood pressure control has been challenged.…”

Section: Consequences Of Poor Adherencementioning

confidence: 99%

Practical issues in medication compliance in hypertensive patients

Krzesinski¹,

Leeman²

2011

RRCC

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Unsatisfactory compliance in the treatment of high blood pressure is frequently due to sequential barriers, such as insufficient patient education about the illness and low motivation to receive any treatment, existence of a large gap between physicians' perceptions of the problem and clinical reality, complexity of the treatment potentially generating adverse effects, and a health care environment with few public education campaigns and incentives for better coordinated supportive care. In order to improve drug compliance, establishment of personalized plans adapted to each patient is required. First, a good doctor-patient relationship is mandatory, with regular education of the patient about hypertension and its risks, discussion about adverse drug effects, and the complexity and cost of treatment. Second, to have any chance of success, the provider should offer convenient appointments and tailor the treatment regimen to the patient's lifestyle and needs, with written instructions. Third, there is a need to promote active patient collaboration with treatment. An innovative combination of home self-measurement of blood pressure, use of new technology options, eg, texting or telemedicine, and creation of a multidisciplinary working team can offer new, effective opportunities. This approach could reduce cardiovascular complications by improving the control of high blood pressure, and thereby the overall costs of hypertension to the health care system.

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Impact of a Better Adherence to Antihypertensive Agents on Cerebrovascular Disease for Primary Prevention

Cited by 132 publications

References 26 publications

Economic evaluation of single-pill combination of indapamide and amlodipine in the treatment of arterial hypertension in the Polish setting

Economic evaluation of single-pill combination of indapamide and amlodipine in the treatment of arterial hypertension in the Polish setting

Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients

Practical issues in medication compliance in hypertensive patients

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