Measuring, Analyzing, and Managing Drug Adherence in Resistant Hypertension

Burnier, Michel; Wuerzner, Grégoire; Struijker‐Boudier, Harry A.J.; Urquhart, John

doi:10.1161/hypertensionaha.113.00687

Cited by 208 publications

(154 citation statements)

References 69 publications

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“…Not every patient has therapy-resistant hypertension, and non-compliance can be one of the reasons for this potentially fatal situation [17], but between 8% and 13% of all hypertensive patients are considered to be truly therapy resistant [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

et al. 2016

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“…The average prescription refill frequency, 42% for the target population and 55% for all relevant patients enrolled, is consistent with most previous studies worldwide. [17][18][19] Second, we demonstrated that, overall, switching from free combinations of 2 antihypertensive drugs to the corresponding SPCs could result in significant improvement in medication adherence in the real world, even after adjustments for the phenomenon of regression to the mean. The magnitude of improvement in adjusted MPR difference observed in the study group (relative and absolute differences in MPR, 50%-61% and 21-26 percentage points, respectively) is greater than that reported in most previous studies, irrespective of the strategies used for improving adherence.…”

Section: Discussionmentioning

confidence: 81%

Bidirectional Adherence Changes and Associated Factors in Patients Switched From Free Combinations to Equivalent Single-Pill Combinations of Antihypertensive Drugs

Wang

Chen

et al. 2014

Hypertension

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958T he complexity of blood pressure regulatory mechanisms suggests that combined use of antihypertensive drugs with different pharmacological actions to achieve synergism is a rational approach to obtain optimal control of hypertension.1 Recent hypertension guidelines also recommend initiating antihypertensive therapy with 2 drugs if blood pressure is >20 mm Hg above systolic goal or >10 mm Hg above diastolic goal. 2,3 In most countries, more than half of treated patients with hypertension are indeed on ≥2 drugs. 2,4 Moreover, patients with hypertension are often associated with other cardiovascular risk factors and comorbidities, which may further increase the pill burden. Therefore, polypharmacy and resultant noncompliance are both frequently encountered problems in the management of hypertension. 5To simplify complex medical regimens and improve adherence, the use of combinations of ≥2 antihypertensive drugs at fixed doses in a single tablet, commonly called fixed-dose combinations or single-pill combinations (SPCs), has been advocated in several hypertension guidelines. 2,3,6,7 In a recent meta-analysis of studies comparing the administration of antihypertensive SPCs with their corresponding free-drug combinations, the compliance rate was improved by 21% in patients receiving SPCs. 8 However, most evidences showing that SPCs were associated with improved adherence are from cohort studies with parallel group comparisons and without adjustments for comorbidities and concomitant medications. The only relevant randomized crossover studies were of small size and conducted ≈3 decades ago.9,10 In other words, there are no reported studies assessing the effects of SPCs on adherence in real-world patients with hypertension switched from free-drug combinations to SPCs. Given that SPCs have also been accused of reduced flexibility in dosing and possible increased adverse effects, it is of importance to examine whether the common practice of switching from free-drug combinations to SPCs does invariably achieve better adherence in diverse patients with hypertension.The computerized claims database of the National Health Insurance (NHI) in Taiwan provides us a unique opportunity to carry out such a study. In this study, we aimed to assess (1) the effect of switching from antihypertensive free-drug Abstract-There are no reported studies assessing the effects of fixed-dose single-pill combinations (SPCs) of antihypertensive drugs on adherence in real-world patients with hypertension switched from free combinations to the corresponding SPCs. In this retrospective cohort study with a 1-year mirror-image design, a total of 896 patients who had been prescribed with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and a thiazide-type diuretic within the preceding 12 months of the index (switching) date and the corresponding SPC within 12 months after the index date were included by using the Taiwan National Health Insurance database from January 2001 to December 2007. Adherence was measured by medicati...

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“…Monitoring the refills of any prescribed medication prior to healthcare visits may facilitate interpreting the STE of prescribed medications prior to adjusting the therapy regimen (291). The clinician may attribute uncontrolled conditions to therapeutic ineffectiveness and increase the dosage of current medications which can potentially lead to ADRs.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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Measuring, Analyzing, and Managing Drug Adherence in Resistant Hypertension

Cited by 208 publications

References 69 publications

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

Effect of Cardiac-Cycle-Synchronized Selective Vagal Stimulation on Heart Rate and Blood Pressure in Rats

Bidirectional Adherence Changes and Associated Factors in Patients Switched From Free Combinations to Equivalent Single-Pill Combinations of Antihypertensive Drugs

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

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