Persistence with Treatment in Newly Treated Middle-Aged Patients with Essential Hypertension

Perreault, Sylvie; Lamarre, Diane; Blais, Lucie; Dragomir, Alice; Berbiche, Djamal; Lalonde, Lyne; Laurier, Catherine; St-Maurice, François; Collin, Johanne

doi:10.1345/aph.1e548

Cited by 77 publications

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“…[1][2][3] An important part of this problem is current prescribing practices. Unfortunately, most patients require Ն2 medications to achieve optimal control, 4 and these multidrug regimens are associated with lower adherence.…”

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confidence: 99%

A Simplified Approach to the Treatment of Uncomplicated Hypertension

et al. 2009

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Abstract-Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure Ͻ140 mm Hg and diastolic blood pressure Ͻ90 mm Hg for patients without diabetes mellitus or systolic blood pressure Ͻ130 mm Hg and diastolic blood pressure Ͻ80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. Key Words: hypertension management Ⅲ randomized, controlled trial Ⅲ fixed-dose combination therapy Ⅲ cluster randomization Ⅲ hypertension T reatment of hypertension remains suboptimal despite the development of novel therapies and the widespread implementation of education programs. Although multiple barriers exist to achieving better control of blood pressure, these mainly consist of patient-and practitioner-centered factors.From the patient perspective, poor adherence to antihypertensive regimens is a significant component of the "treatment gap." 1-3 An important part of this problem is current prescribing practices. Unfortunately, most patients require Ն2 medications to achieve optimal control, 4 and these multidrug regimens are associated with lower adherence. 5,6 This has been suggested to be the most important contribution to inadequate blood pressure control. 7 Furthermore, switching medications, a strategy featured prominently in most national treatment guidelines, has also been linked to poor adherence. 8 Thus, the use of simpler, more effective drug regimens might improve blood pressure control.From a practitioner perspective, a number of behavioral factors have been associated with poor blood pressure control. One of the most important factors is "therapeutic inertia," whereby practitioners fail to appropriately escalate the intensity of therapy despite the presence of poorly controlled hypertension. 9 We speculate that the increasingly complex treatment regimens currently advocated by experts, national guidelines, and the pharmaceutical industry might contribute to this undesirable behavior.Given these issues, a simple, step-care-based algorithm for the pharmacological management of hypertension (Simplified Treatment Intervention to Control Hypertension [STITCH]) was developed. This algorithm...

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A Simplified Approach to the Treatment of Uncomplicated Hypertension

et al. 2009

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“…Combination products were excluded because the single angiotensin system-blocking agents area ssociated with significantly higher persistence rates than other antihypertensive drug classes. 36 By limiting the analysis to single-agent angiotensin system blockers, we reduce the potential for agents such as hydrochlorothiazide in combination products to negatively influence persistence. An ew user was defined as an individual who started treatment with ACEI (Medi-Span' s6 -digit Generic Product Identifier [GPI] code 361000) or ARB (code 361500) single agents (excluding ACEI/ calcium channel blockers, ACEI/hydrochlorothiazide, and ARB/ hydrochlorothiazide combinations) between January1 ,2 004 and June 30, 2004 with no ACEI or ARB single agents or combinations dispensed in the 6m onths (180 days) preceding the index date.…”

Section: Nn Methodsmentioning

confidence: 99%

“…[6][7]23,25,[31][32][33]36,[38][39][40][41] Andersen' sm odel was originally developed in the late 1960s to explain how and why families use health services. This model has since been adapted to predict and explain prescription drug use.…”

Section: Variablesmentioning

confidence: 99%

“…Some empirical studies have shown that age and race were significant predictors of medication persistence. 31,36,38,[40][41] Benner et al, for example, reported that members of black and other nonwhite races werel ess persistent with statin therapy. 41 Although we also found as ignificant association between persistence and race, this finding should be interpreted cautiously.B ecause claims data do not include race at the individual level, we measured race at an aggregate level (i.e., percentage of population in the patient' sZ ip Code area selfreporting white as their only racial group).…”

Section: Journal Of Managed Care Pharmacy 673mentioning

confidence: 99%

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Relationship of the Magnitude of Member Cost-Share and Medication Persistence With Newly Initiated Renin Angiotensin System Blockers

Zhang

Schondelmeyer²,

Schommer³

et al. 2007

JMCP

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What this study adds• Among members newly initiating angiotensin system blocking medication, each $1 increment in member cost-sharefor the initial prescription claim was associated with 2.8% greater odds of being nonpersistent at 6months after initiating therapy.•A mong members newly initiating angiotensin system blocking medication, each $1 in member cost-sharefor the initial prescription claim was associated with a1.9% increase in total medication gap in therapy.•T he magnitude of member cost-sharewas found to have a consistent effect on medication persistence by 3measures: total gap, odds of being nonpersistent, and risk for a30day gap.•I naquasi-experimental (pre-post with comparison group) study,rates of persistency with antihypertensive therapy were not significantly affected by the implementation of acost-share increase of $13 per prescription for 29% of antihypertensive use and $1 to $3 for the remaining 71% of antihypertensive use.•W hen comparing antihypertensive persistence among 3benefit tiers (generics, preferred brands, and nonpreferred brands), using the measureofproportion of days covered, researchers have found an inverse association between costshareand persistence.•T he quantitative relationship between antihypertensive costsharing and persistence among members newly initiating therapy is unknown.aBsTRacT

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“…В связи с этим на современном этапе активно изучаются различные пути повышения приверженности антигипертензивной терапии. Среди факторов, спо-собных повышать приверженность проводимой те-рапии, большое значение уделяется информирован-ности больных об их заболевании, особенностях течения, терапии, необходимости лечения артери-альной АГ, ее осложнениях, а также о последствиях низ-кой приверженности [14,15]. В этом отношении за-служивает внимания электронная версия SCORE, ко-торая позволяет в режиме online не только быстро оце-нить суммарный риск, но и может повысить мотива-цию пациентов к медикаментозной и немедикамен-тозной терапии.…”

Section: Adherence To Treatment Of Hypertension and Dyslipidemia привunclassified

Is It Possible to Improve the Adherence to Treatment of Hypertension and Dyslipidemia in Patients Without Clinical Manifestations of Atherosclerosis?

Сарычева

Небиеридзе

Kamyshova

2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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1 Клиническая больница №1, Управление делами Президента РФ Россия, 121352, Москва, Староволынская ул., 10 2 Национальный медицинский исследовательский центр профилактической медицины Россия, 101990, Москва, Петроверигский пер., 10, стр. 3Поиск эффективных способов повышения приверженности терапии у пациентов с артериальной гипертензией (АГ) высокого риска является важнейшей задачей в плане снижения заболеваемости и смертности от сердечно-сосудистых заболеваний. Цель. Изучить возможности повышения приверженности терапии у пациентов с АГ высокого риска с дислипидемией (ДЛП) при помощи элек-тронной версии шкалы SCORE в первичном звене здравоохранения. Материал и методы. Обследовано 300 пациентов с АГ и ДЛП в возрасте от 40 до 65 лет без клинических проявлений атеросклероза, обра-тившихся на прием к врачу в первичное звено здравоохранения (ведомственная поликлиника г. Москвы). В исследование включены пациенты высокого риска (n=150), у которых были выявлены поражения органов-мишеней (микроальбуминурия, гипертрофия левого желудочка, суб-клинический атеросклероз сонных артерий). Пациенты рандомизированы в основную (n=76) и контрольную группы (n=74). Всем пациен-там была назначена антигипертензивная и гиполипидемическая терапия, даны рекомендации по здоровому образу жизни. В основной груп-пе с помощью электроннной версии SCORE демонстрировалась позитивная динамика риска в случае достижения целевых уровней артериального давления (АД), общего холестерина, отказа от курения, снижения веса. Пациентам контрольной группы наглядная демонстрация не прово-дилась. Длительность исследования составила 12 мес. Оценивалось достижение целевых значений АД и липидных показателей, коррекция факторов риска, динамика риска по SCORE, приверженность терапии по шкале Мориски-Грина. Результаты. К концу исследования средний балл по шкале Мориски-Грина в основной группе составил 2,14 против 1,27 в контрольной (p<0,001). Сохранение антигипертензивной терапии в основной группе составило 8,8 мес., на терапии статинами -6,74 мес, а в контроле -5,73 мес и 3,6 мес, соответственно (p<0,001). Достижение целевых уровней АД и общего холестерина в основной группе составило 55,3% и 35,5%, со-ответственно, в группе контроля -18,9% и 10,8% (p<0,001). Риск по шкале SCORE был значимо ниже в основной группе, чем в контрольной (4,09 против 5,25, соответственно). Заключение. Демонстрация электронной версии SCORE среди больных высокого риска с АГ и ДЛП позволяет повысить приверженность па-циентов лечению. Это приводит к повышению эффективности проводимой терапии, лучшему контролю АД, липидных показателей, коррек-ции других модифицируемых факторов риска и, как следствие, к уменьшению общего сердечно-сосудистого риска.Ключевые слова: артериальная гипертензия, высокий риск, приверженность терапии, электронная версия SCORE. The search for effective ways to improve adherence to medication in patients with hypertension at high risk is critical in reducing morbidity and mortality from cardiovascular diseases. Aim. To assess the possibility of improving adherence to therap...

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Persistence with Treatment in Newly Treated Middle-Aged Patients with Essential Hypertension

Abstract: Barriers to persistence occur early in the course of therapy, and adherence continues to decline over a period of 3 years. Patients were least persistent to diuretic therapy.

Cited by 77 publications

References 0 publications

A Simplified Approach to the Treatment of Uncomplicated Hypertension

A Simplified Approach to the Treatment of Uncomplicated Hypertension

Relationship of the Magnitude of Member Cost-Share and Medication Persistence With Newly Initiated Renin Angiotensin System Blockers

Is It Possible to Improve the Adherence to Treatment of Hypertension and Dyslipidemia in Patients Without Clinical Manifestations of Atherosclerosis?

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