Patient compliance and therapeutic coverage: comparison of amlodipine and slow release nifedipine in the treatment of hypertension

Abstract

To study patient compliance in hypertensive outpatients amlodipine (5 mg once daily) and slow release nifedipine (20 mg twice daily) were compared in an open, crossover study in general practices. Four methods of assessment for patient compliance (pill count, taking compliance, days with correct dosing, timing compliance) were used in both study arms. For the latter three assessment a special device, the medication event monitoring system, was used to record the time and date of each opening and closure of the container. The compliance of the 320 hypertensive patients with once-daily amlodipine was markedly superior to twice-daily slow release nifedipine. Therapeutic coverage was also significantly better for amlodipine in the hypertensive patients. Amlodipine was better tolerated than nifedipine slow release. Patient compliance and therapeutic coverage with the calcium antagonist amlodipine given once daily was superior to slow release nifedipine b.d. in hypertensive outpatients recruited in general practice.

Objective assessment of nonadherence and unknown co-medication in hospitalized patients

“…While adherence in general was fair, 30% of patients were adherent only to some drugs while exposure to other drugs was absent. This is compatible with the notion that nonadherence can happen consciously as well as unconsciously [26]. As expected [27], in our study nonadherence modestly increased with the number of drugs the patient had been prescribed.…”

Use of electronic pill boxes to assess risk of poor treatment compliance Results of a large-scale trial

“…[13][14][15] Three recent studies using electronic pill boxes have also shown a lower compliance when using twice daily drugs compared to once daily drugs. 8,16,17 By extrapolation, it may seem obvious that compliance should be better in patients treated by a single drug rather than several. Our results suggest just the opposite; compliance increased with the number of drugs prescribed.…”

“I don’t know how many of these [medicines] are necessary..”—A focus group study among elderly users of multiple medicines

“…Multiple diseases and complex medicine regimes in elderly patients may compromise adherence even further [3,4]. Studies of regimen simplification, like reduced dose frequency, often focus on patient adherence only and fail to include measures of satisfaction or acceptability by patients or show that simplification leads to clinical improvements [5][6][7][8][9].…”