Meta-Analysis

Abstract

Background Observational studies suggest there are differences in adherence to antihypertensive medications in different classes. Our objective was to quantify the association between antihypertensive drug class and adherence in clinical settings. Methods and Results Studies were identified through a systematic search of English-language articles published from inception of computerized databases till February 1, 2009. Studies were included if they measured adherence to antihypertensives using medication refill data and contained sufficient data to calculate a measure of relative risk of adherence and its variance. An inverse-variance weighted random-effects model was used to pool results. Hazard ratios (HR) and odds ratios (OR) were pooled separately, and HRs were selected as the primary outcome. Seventeen studies met inclusion criteria. The pooled mean adherence by drug class ranged from 28% for beta-blockers to 65% for angiotensin II-receptor blockers (ARBs).There was better adherence to ARBs compared to angiotensin-converting enzyme inhibitors (ACEIs) (HR 1.33, 95%CI 1.13–1.57), calcium channel blockers (HR 1.57, 95% CI 1.38–1.79), diuretics (HR 1.95, 95%CI 1.73–2.20), and beta-blockers (HR 2.09, 95%CI 1.14–3.85). Conversely, there was lower adherence to diuretics compared to the other drug classes. The same pattern was present when pooling studies that used ORs. When accounting for publication bias, there were no longer significant differences in adherence between ARBs and ACEIs or between diuretics and beta-blockers. Conclusion In clinical settings, there are important differences in adherence to antihypertensives in separate classes with lowest adherence to diuretics and beta-blockers and highest to ARBs and ACEIs. Yet, adherence was suboptimal regardless of drug class.

Adherence to Antihypertensive Medication in Treatment‐Resistant Hypertension Undergoing Renal Denervation

“…Accordingly, central systolic pressure and augmentation index were higher in nonadherent patients. Similar to other reports, drug class did not appear to have any important impact on the adherence and nonadherence rates in patients with TRH; this result contrasts with findings in mild to moderate hypertension8, 9 (Figure 1). …”

“…Several outcome research studies found that nonadherence to antihypertensive agents significantly increased cardiac and cerebrovascular risk 5, 6, 7. Furthermore, the choice of prescribed drug class affects adherence rates of antihypertensive therapies 8, 9. In patients with treatment‐resistant hypertension (TRH), who are treated on average with 5 to 6 antihypertensive agents, fixed‐dose combinations mitigate the problem of taking multiple pills per day, but in addition to the antihypertensive agents, these comorbid patients generally require additional cardioprotective drugs (eg, statins, antidiabetic agents) 1, 10…”

The causes of low adherence in patients with antihypertensive therapy

“…In other study this information confirmed that lower adherence was associated with more prescribed medications [10], especially in users of diuretics and beta blockers, rarely in users of angiotensin -converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) [11], which was promoted by…”

Диуретики В Лечении Артериальной Гипертензии: Так Ли Они Плохи И Все Ли Одинаковы? Часть 2

“…Через год остаются на терапии диуретиками 20,8 % пациентов, через 4 года -16,4 %, что в два раза ниже, чем на терапии бета-блокаторами. Эти данные подтвеждаются и результатами метаанализа I. Kronish с соавторами, в котором было продемонстрировано, что наихудшая приверженность у диуретиков и бета-бло-каторов [33]. В то же время рандомизированные иссле-дования говорят о том, что тиазидоподобные диуретки, наоборот, имеют хорошую переносимость и высокую приверженность.…”