1
|
Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites 2023; 13:1087. [PMID: 37887412 PMCID: PMC10609002 DOI: 10.3390/metabo13101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.
Collapse
Affiliation(s)
- Vittorio Venditti
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Enrico Bleve
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Susanna Morano
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Tiziana Filardi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
| |
Collapse
|
2
|
Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
Collapse
Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
| |
Collapse
|
3
|
Kim MC, Ahn Y, Kim MH, Kim SY, Hong TJ, Rhee MY, Kim SH, Hong SJ, Kim H, Kim W, Chae IH, Kang DH, Kim BK, Kim HS. A Randomized, Multicenter, Double-blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of a Quadruple Combination of Amlodipine, Losartan, Rosuvastatin, and Ezetimibe in Patients with Concomitant Essential Hypertension and Dyslipidemia. Am J Cardiovasc Drugs 2023:10.1007/s40256-023-00590-9. [PMID: 37395974 DOI: 10.1007/s40256-023-00590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Few data are available regarding the efficacy and safety of a single-pill combination (SPC) consisting of four medications in patients with concomitant hypertension and dyslipidemia. OBJECTIVE We aimed to determine the efficacy and tolerability of a fixed-dose SPC consisting of 5 mg amlodipine, 100 mg losartan, 20 mg rosuvastatin, and 10 mg ezetimibe (A/L/R/E) in patients with concomitant hypertension and dyslipidemia. METHODS This was a 14-week, randomized, multicenter, double-blind, placebo-controlled, phase III clinical trial. In total, 145 patients were randomized to receive A/L/R/E, A/L, or L/R/E. The primary endpoints were the average change in the low-density lipoprotein cholesterol (LDL-C) level in the A/L/R/E and A/L groups and the sitting systolic blood pressure (sitSBP) in the A/L/R/E and L/R/E groups. The numbers of patients with adverse drug reactions (ADRs) were compared as safety variables. RESULTS The average percentage change in the LDL-C level as the least squares mean (LSM) from the baseline LDL-C level at the end of the 8-week treatment was - 59.0% in the A/L/R/E group and 0.2% in the A/L group (LSM difference - 59.2, 95% confidence interval [CI] - 68.1 to - 50.4; p < 0.0001). The average change in the sitSBP as the LSM was - 15.8 mmHg in the A/L/R/E group and -4.7 mmHg in the L/R/E group (LSM difference - 11.1, 95% CI - 16.8 to - 5.4; p = 0.0002). No ADRs occurred in the A/L/R/E group. CONCLUSIONS A/L/R/E as an SPC could be an effective treatment for patients with hypertension and dyslipidemia without significant safety issues. CLINICAL TRIALS REGISTRATION NCT04074551 (registered 30 August 2019).
Collapse
Affiliation(s)
- Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical School, Pusan, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Medical School, Pusan, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Seoul Boramae Hospital, Seoul National University Medical School, Seoul, Republic of Korea
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University Medical School, Seoul, Republic of Korea
| | - In Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University Medical School, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
4
|
Tamargo J, Caballero R, Mosquera ED. Sex and gender differences in the treatment of arterial hypertension. Expert Rev Clin Pharmacol 2023; 16:329-347. [PMID: 36891888 DOI: 10.1080/17512433.2023.2189585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Arterial hypertension represents the leading modifiable risk factor for all-cause death and early development of cardiovascular disease in women. Current clinical guidelines for the treatment of hypertension noted that women respond to antihypertensive drugs similarly to men and, therefore, treatment recommendations remain the same for both sexes. However, clinical evidence suggests the existence of sex- and gender-related differences (SGRD) in the prevalence, pathophysiology, pharmacodynamics (efficacy and safety) and pharmacokinetics of antihypertensive drugs. AREAS COVERED This review summarizes SGRD in the prevalence of hypertension, hypertension-mediated organ damage and blood pressure control, prescription patterns, and pharmacokinetics/ pharmacodynamics and doses of antihypertensive drugs. EXPERT OPINION There is limited information on SGRD in antihypertensive drug efficacy because of the underrepresentation of women in randomized clinical trials and, more important, because few trials reported results stratified by sex or performed sex-specific analyses. However, there are SGRD in hypertension-mediated organ damage, drug pharmacokinetics and, particularly, in drug safety. Prospective trials specifically designed to better understand the basis for SGRD in the pathophysiology of hypertension and in the efficacy and safety of antihypertensive drugs are needed to achieve a more personalized treatment of hypertension and hypertension-mediated organ damage in women.
Collapse
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Eva Delpón Mosquera
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| |
Collapse
|
5
|
A Study on Types of Medication Adherence in Hypertension among Older Patients and Influencing Factors. Healthcare (Basel) 2022; 10:healthcare10112322. [DOI: 10.3390/healthcare10112322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Hypertension has the characteristic that the risk of complications can be reduced through appropriate medication in daily life. Hence, it is important to consider practical measures to increase medication adherence, particularly among older patients. Methods: This study used the Korea Health Panel 2020 data (Version 2.0.1), jointly conducted by Korea Institute for Health and Social Affairs and National Health Insurance. A total of 2300 patients with high blood pressure over 65 years of age were selected. In order to identify types of medication adherence in older hypertensive patients, and examine factors that influence the types, the Latent Profile Analysis (LPA) and logistic regression were performed. Results: The types of adherence groups were classified into two groups: an ‘adherence group’ (87.1%) and a ‘non-adherence group’ (12.9%). Furthermore, age, living alone, and depressive symptoms were identified as determinants of medication adherence type among older hypertensive patients. Conclusion: The significant impact of sociodemographic status (age, living alone, and depressive symptoms) on medication adherence among older hypertensive patients indicates the need to establish more specific empirical interventions based on each type’s characteristics. It is expected that this study will provide an in-depth understanding of factors associated with medication adherence among older patients with hypertension, which can support interventions tailored to the specific needs of those who are non-adherent.
Collapse
|
6
|
Savaré L, Rea F, Corrao G, Mancia G. Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database. J Hypertens 2022; 40:1768-1775. [PMID: 35881457 PMCID: PMC10860882 DOI: 10.1097/hjh.0000000000003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the use of antihypertensive combination treatment, both as the initial and as a subsequent therapeutic step, in a large Italian population. METHODS The residents of the Lombardy Region (Italy), aged 40 years or older, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified and the drug treatment strategy (monotherapy and combination of two, three and more than three antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories. RESULTS About 100 000 patients were identified for each cohort. Monotherapy was the most common initial treatment strategy (75%), followed by two-drug single-pill combination (16%), two-drug free combination (6%), and combination of at least three drugs (3%). Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (>2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories. CONCLUSION Our data show that in a real-life population use of antihypertensive drug combinations is low. They also show that, contrary to guideline recommendations, antihypertensive combination treatment did not show any noticeable increase in recent years.
Collapse
Affiliation(s)
- Laura Savaré
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- MOX - Laboratory for Modeling and Scientific Computing, Department of Mathematics, Politecnico di Milano, Milan
- CHDS - Center for Health Data Science, Human Technopole, Milan
| | - Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca
| | | |
Collapse
|
7
|
González-Rodríguez A, Monreal JA, Mv MVS. Factors Influencing Adherence to Antipsychotic Medications in Women with Delusional Disorder: A Narrative Review. Curr Pharm Des 2022; 28:1282-1293. [PMID: 35272589 DOI: 10.2174/1381612828666220310151625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and function. OBJECTIVE To review influences on adherence to antipsychotic medications, the treatment of choice for delusional disorder (DD), and to focus on adherence in women with DD. METHOD A non-systematic narrative review of papers published since 2000 using PubMed and Google Scholar and focusing on women with DD and medication adherence. RESULTS Several factors have been identified as exerting influence on adherence in women with persistent delusional symptoms who are treated with antipsychotics. Personality features, intensity of delusion, perception of adverse effects, and cognitive impairment are patient factors. Clinical time spent with the patient, clarity of communication and regular drug monitoring are responsibilities of the health provider. Factors that neither patient nor clinician can control are the social determinants of health such as poverty, easy access to healthcare, and cultural variables. CONCLUSIONS There has been little investigation into factors that influence adherence in the target population discussed here -e.g. women with DD. Preliminary results of this literature search indicate that solutions from outside the field of DD may apply to this population. Overall, a solid therapeutic alliance appears to be the best hedge against non-adherence.
Collapse
Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health. Mutua Terrassa University Hospital. University of Barcelona. Terrassa, Barcelona, Spain
| | - José Antonio Monreal
- Department of Mental Health. Mutua Terrassa University Hospital. University of Barcelona. Institut de Neurociències. UAB. CIBERSAM, Terrassa, Barcelona, Spain
| | | |
Collapse
|
8
|
Hamrahian SM, Maarouf OH, Fülöp T. A Critical Review of Medication Adherence in Hypertension: Barriers and Facilitators Clinicians Should Consider. Patient Prefer Adherence 2022; 16:2749-2757. [PMID: 36237983 PMCID: PMC9552797 DOI: 10.2147/ppa.s368784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Hypertension is a global public health problem, and its prevalence is increasing worldwide. Impacting all human societies and socioeconomic strata, it remains the major modifiable risk factor for global burden of cardiovascular disease all-cause mortality and the leading cause of loss of disability-adjusted life years. Despite increased awareness, the rate of blood pressure control remains unsatisfactory, particularly in low- to middle-income countries. Apparent treatment-resistant hypertension is associated with worse adverse health outcomes. It includes both true resistant and pseudo-resistant hypertension, which requires out-of-office blood pressure monitoring to exclude white-coat effect and confirmation of adherence to the agreed recommended antihypertensive therapy. The depth of medication non-adherence remains poorly recognized among medical practitioners, thus presenting an underestimated modifiable risk factor. Medication non-adherence is a complex and multidimensional variable with three quantifiable phases: initiation, implementation, and discontinuation, collectively called persistence. Non-adherence can be both intentional and non-intentional and usually involves several interconnected factors. Persistence declines over time in the treatment of chronic diseases like hypertension. The risk is higher in patients with new diagnosis, poor insurance status, polypharmacy, and multiple comorbidities, particularly psychiatric disorders. The World Health Organization divides the contributing factors impacting adherence into five categories. Screening and detection for medication non-adherence are challenging due to its dynamic nature and potential white-coat effect. Easy-to-conduct screening methods have low reliability and validity, whereas more reliable and valid methods are costly and difficult to perform. Medication non-adherence is associated with poor clinical outcome and potential negative impact on health-care costs. Evaluation of adherence should become an integral part of assessment of patients treated for hypertension. Medication adherence can significantly improve with a patient-centered approach, non-judgmental communication skills, and collaborative multidisciplinary management, including engagement of the patients in their care by self-blood pressure monitoring.
Collapse
Affiliation(s)
- Seyed Mehrdad Hamrahian
- Department of Medicine - Nephrology, Thomas Jefferson University, Philadelphia, PA, USA
- Correspondence: Seyed Mehrdad Hamrahian, Department of Medicine - Nephrology, Thomas Jefferson University, 33S 9th Street, Suite 700, Philadelphia, PA, 19107, USA, Tel +1 215-503 3000, Fax +1 215-503 4099, Email
| | - Omar H Maarouf
- Department of Medicine - Nephrology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tibor Fülöp
- Department of Medicine - Nephrology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
9
|
OUP accepted manuscript. Eur Heart J 2022; 43:3312-3322. [DOI: 10.1093/eurheartj/ehab899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
|
10
|
Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S, Maddury SR, Kumar AS, Chandra N, Suryaprakash G, Thomas JM, Juvale NI, Sathe S, Khan A, Bansal S, Kumar V, Reddi R. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J 2021; 73:667-673. [PMID: 34861979 PMCID: PMC8642659 DOI: 10.1016/j.ihj.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN.
Collapse
Affiliation(s)
- Jamshed J Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India.
| | | | - Arup Dasbiswas
- Department of Cardiology, NRS Medical College, Kolkata, West Bengal, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | | | | | | | | | - Joy M Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, India.
| | - N I Juvale
- Department of Cardiology, Saifee Hospital, Mumbai, India.
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, India.
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Medical College, Delhi, India.
| | | | - Rajshekhar Reddi
- Department of Neurology, Max Superspecialty Hospital, Saket, New Delhi, India.
| |
Collapse
|
11
|
Rea F, Savaré L, Franchi M, Corrao G, Mancia G. Adherence to Treatment by Initial Antihypertensive Mono and Combination Therapies. Am J Hypertens 2021; 34:1083-1091. [PMID: 34037713 DOI: 10.1093/ajh/hpab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/14/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Aim of our study was to compare adherence to antihypertensive drug therapy between newly treated patients in whom monotherapy or a 2-drug single-pill combination (SPC) was initially dispensed. METHODS The 63,448 residents of Lombardy Region (Italy), aged 40-80 years, who were newly treated with antihypertensive drugs during 2016, were identified and followed for 1 year after the first prescription. The outcome of interest was adherence to drug therapy that was measured according to the "proportion of days covered" (PDC) criterion, i.e., the ratio between the number of days in which the drug was available and the days of follow-up. Patients who had a PDC >75% and <25% were defined as highly and poorly adherent to drug therapy, respectively. Log-binomial regression models were fitted to compare the propensity to treatment adherence between the initial therapeutic strategies, after adjusting for baseline demographic and clinical covariates. RESULTS About 46% and 17% of patients showed high and poor adherence, respectively. Compared with patients under initial monotherapy (85%), those who were initially treated with a SPC (15%) had higher propensity to be highly adherent and a lower propensity to be poorly adherent to antihypertensive treatment (risk ratio: 1.18, 95% confidence interval 1.16-1.21; 0.42, 0.39-0.45, respectively). This was the case regardless the sex, the age, the patient clinical status, and with almost any type of SPC. CONCLUSIONS In a real-life setting, patients who were initially prescribed a 2-drug SPC exhibited more frequently a good adherence to antihypertensive treatment than those starting with a single drug.
Collapse
Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Laura Savaré
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca (Emeritus Professor), Milan, Italy
- Policlinico di Monza, Monza, Italy
| |
Collapse
|
12
|
Abdel Aal A, Youssef G, El Faramawy A, El Remisy D, El Deeb H, El Aroussy W, Ibrahim MM. Registry of the Egyptian specialized hypertension clinics: Sex-related differences in clinical characteristics and hypertension management among low socioeconomic hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:1120-1128. [PMID: 33774923 PMCID: PMC8678729 DOI: 10.1111/jch.14231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) which is a leading cause of death in developing countries affecting both genders. Gender dissimilarity in clinical characteristics and hypertension (HTN) management among hypertensive patients has been reported in several reports before. The aim was to detect sex differences in clinical characteristics and HTN management among Egyptian hypertensive patients. Data from 4701 hypertensive patients attending 9 university located Specialized Hypertension clinic (SHC) were collected from October 2014 to September 2017. The collected data included demographics, cardiovascular risk profile, hypertension‐related history, anthropometric and blood pressure (BP) measurements, antihypertensive medications used, number of patients attending the follow‐up visits, and HTN control rate. Females represented 58.5% of the recruited patients, they were younger, with higher BMI, lower education level, and employment rate compared with males. Females had lower mean office systolic and diastolic BP than males (144.2 ± 22.6 vs. 146.5 ± 22.0 mmHg and 88.1 ± 13.0 vs. 89.9 ± 12.6 mmHg, respectively) and lower rate of uncontrolled BP (54.8% vs. 61.1% in males P < .001). Antihypertensive drugs were comparable among both sexes except for angiotensin converting enzyme inhibitors which were more prescribed in males. Compliance to antihypertensive medications was better in females (63.6% vs. 60.1% in males, P = .015). To conclude, Egyptian hypertensive females have different clinical characteristics as compared to their counterpart males with better BP control, adherence to antihypertensive medications, lower systolic and diastolic BP, and no major differences in the prescribed antihypertensive distribution.
Collapse
Affiliation(s)
- Amr Abdel Aal
- Faculty of Medicine, Department of Cardiology, Helwan University, Cairo, Egypt
| | - Ghada Youssef
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Amr El Faramawy
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Dalia El Remisy
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Heba El Deeb
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| | - Wafaa El Aroussy
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| | - M Mohsen Ibrahim
- Faculty of Medicine, Department of Cardiology, Cairo University, Cairo, Egypt
| |
Collapse
|
13
|
Women discontinue antihypertensive drug therapy more than men. Evidence from an Italian population-based study. J Hypertens 2020; 38:142-149. [PMID: 31464801 DOI: 10.1097/hjh.0000000000002222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several factors affect adherence to antihypertensive drug treatment, but whether these factors include a sex difference is unclear. Aim of the study was to compare persistence with antihypertensive drug therapy between men and women in a large cohort of patients. METHODS The 60 526 residents of the Italian Lombardy Region aged 40-80 years newly treated with antihypertensive drugs during 2010 were identified and followed for 1 year after the first prescription. Discontinuation of treatment was defined as lack of prescription renewal for at least 90 days. Log-binomial regression models were fitted to estimate the risk ratio of treatment discontinuation in relation to sex. Other than for the whole population, analyses were stratified according to age, comorbidity status and the initial antihypertensive treatment strategy. RESULTS Thirty-seven percent of the patients discontinued the drug treatment during follow-up. Compared with women, men had a 10% lower risk of discontinuation of drug treatment (95% confidence interval: 8-12). Persistence on antihypertensive treatment was better in men than in women, this being the case in both younger (40-64 years) and older patients (65-80 years), in patients starting treatment with any major antihypertensive drug and in patients who had a low comorbidity status. There was no evidence that men and women had a different risk of treatment discontinuation when their comorbidity status was worse, or initial antihypertensive treatment was based on drug combinations. CONCLUSION Our data show that in a real-life setting, men are more persistent to antihypertensive drug therapy than women.
Collapse
|
14
|
Blood pressure distribution and control in coronary patients from 24 European countries in the European Society of Cardiology EURoObservational Research Programme European survey of cardiovascular disease prevention and diabetes. EUROASPIRE IV Registry. J Hypertens 2020; 37:2015-2023. [PMID: 31246889 DOI: 10.1097/hjh.0000000000002130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertension is the most prevalent major independent risk factor for developing coronary heart disease (CHD). The present analysis aimed to assess blood pressure (BP) distribution and factors associated with insufficient BP control in coronary patients from 24 countries participating in the European Society of Cardiology (ESC) EURoObservational Research Programme (EORP) EUROASPIRE IV survey. METHODS EUROASPIRE IV is a cross-sectional study conducted in 2012-2013 in patients aged 80 years or less hospitalized for CHD with a follow-up visit at a median of 16 months later. Logistic regression analysis was applied to confirm factors associated with BP control defined as less than 140/90 mmHg for nondiabetic patients and less than 140/85 mmHg for diabetic patients. RESULTS A total of 7998 patients (response rate, 48.7%) attended the follow-up visit. Complete data were available in 7653 participants (mean age 62.5 ± 9.6 years). The BP goal was achieved in 57.6%. Patients failing to achieve the BP goal were older, had higher BMI, had more often a history of coronary artery bypass grafting (CABG) and reported diabetes more frequently. Logistic regression confirmed the following independent significant predictors of not achieving the BP goal: a history of diabetes [odds ratio (OR) 1.75], obesity (OR 1.70 vs. normal BMI), overweight (OR 1.28 vs. normal BMI), age at least 65 years (OR 1.53) and CABG as the index event (OR 1.26 vs. acute MI). CONCLUSION EUROASPIRE IV found insufficient BP control in a large proportion of patients with stable CHD, with diabetes, increased BMI, older age and CABG as the index event being independent predictors of poor BP control.
Collapse
|
15
|
Abstract
: Chronic kidney disease (CKD) is a public health threat with impact in cardiovascular risk. All forms of cardiovascular disease and mortality are more common in CKD. Treatment of cardiovascular risk factors, hypertension, dyslipidemia and diabetes is essential for cardiovascular and kidney protection. CKD is a marker of high or very high cardiovascular risk and its presence require early treatment and specific goals. Lifestyle is a pivotal factor, stopping smoking, reducing weight in the overweight or obese, starting regular physical exercise and healthy dietary pattern are recommended. Office BP should be lowered towards 130/80 mmHg or even lower if tolerated with sodium restriction and single pill combination, including angiotensin system blocker. Out-of-office BP monitoring, mainly 24-h assessment, is recommended. Diabetes requires treatment from the moment of diagnosis, but prediabetes benefits with lifestyle changes and metformin in patients stage 2 and 3a. iSGLT2 and GLP-1RA are initially recommended in T2D patients with high or very high cardiovascular risk. Concerning dyslipidemia, for patients in stage 4, LDL-C 55 mg/dl or less (1.4 mmol/l) and an LDL-C reduction of 50% or less from baseline is recommended. In stage 3, LDL-C goal is 70 mg/dl or less (1.8 mmol/l) and an LDL-C. reduction of at least 50% from baseline. Statins are the lipid-lowering therapy of choice with or without ezetimibe. Higher doses of statins are required as GFR declines. Available evidence suggests that combined PCSK9 inhibitors with maximally tolerated dose of statins may have an emerging role in treatment of dyslipidemia in CKD patients.
Collapse
|
16
|
Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. Front Cardiovasc Med 2020; 7:49. [PMID: 32318584 PMCID: PMC7154079 DOI: 10.3389/fcvm.2020.00049] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertension is highly prevalent after the age of 65 years affecting more than 60% of individuals in developed countries. Today, there is sufficient evidence from clinical trials that treating elderly subjects with hypertension with antihypertensive medications has a positive benefit/risk ratio even in very elderly patients (>80 years). In recent years, partial or total non-adherence has been recognized as major issues in the long-term management of hypertension in all age categories. However, whether non-adherence is more frequent in hypertensive patients older than 65 years or not is still a matter of debate and the common belief is that adherence is lower in older than in younger patients. Are clinical data supporting this belief? In this brief review, we discuss the topic of drug adherence in elderly in the context of the medical treatment of hypertension. Studies show that drug adherence is actually better in patients aged 65 to 80 years when compared to younger hypertensive patients (<50 years). However, in very old patients (>80 years) the prevalence of non-adherence does increase. In this patients' group, there are specific risk factors for non-adherence such as cognitive ability, depression, and health believes, in addition to classical risk factors for non-adherence. One important aspect in the elderly is the prescription of potentially inappropriate medications that will interfere with the adherence to necessary treatments. In this context, an interesting new concept was developed few years ago, i.e., the process of deprescribing. Thus, today, in addition to conventional guidelines recommendations (use of single pill combinations, individualization of treatments), the evaluation of cognitive abilities, the regular assessment of potentially inappropriate medications, and the process of deprescribing appear to be three new additional steps to improve drug adherence in the elderly and thereby ameliorate the global management of hypertension.
Collapse
Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
| | - Erietta Polychronopoulou
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
| |
Collapse
|
17
|
Visit-to-visit blood pressure variability in patients with type 2 diabetes with and without previous history of cardiovascular disease. J Hypertens 2020; 38:1737-1744. [DOI: 10.1097/hjh.0000000000002443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
18
|
Cui B, Dong Z, Zhao M, Li S, Xiao H, Liu Z, Yan X. Analysis of Adherence to Antihypertensive Drugs in Chinese Patients with Hypertension: A Retrospective Analysis Using the China Health Insurance Association Database. Patient Prefer Adherence 2020; 14:1195-1204. [PMID: 32764892 PMCID: PMC7373416 DOI: 10.2147/ppa.s243665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the adherence to antihypertensive drugs in Chinese patients with hypertension and the factors associated with the drug adherence. METHODS The data for this analysis were obtained from the 2014 China Health Insurance Association (CHIRA) database. The study included 64,576 patients aged ≥18 years who were prescribed one of the seven antihypertensive drugs included in the study in their first prescription in 2014 and were observed for ≥180 days. The medicine possession ratio (MPR) was calculated and taken as the measure of treatment adherence. MPR values <0.3, 0.3 to <0.5, 0.5 to <0.8, and ≥0.8 were considered treatment adherence very low, low, intermediate, and high, respectively. Descriptive statistics were used to present baseline data and treatment adherence rate. Multiple regression models were used to determine independent factors which can affect the treatment adherence rate. P-value <0.05 was considered significant. RESULTS Among the study antihypertensive drugs, amlodipine (33.98%), metoprolol (25.04%), and nifedipine (17.15%) were the frequently prescribed drugs. Nifedipine controlled release tablet had the highest MPR (0.61), followed by valsartan (0.53), valsartan/amlodipine fixed-dose combination (0.50), indapamide (0.40), and amlodipine (0.39), whereas benazepril (0.27) and metoprolol (0.19) had the lowest MPR. Higher reimbursement ratio, regular tertiary hospitals visits, lower age, and lower daily medical cost positively affected treatment adherence, whereas longer duration of illness and higher daily average cost affected treatment adherence negatively. CONCLUSION Our study assessed that prescribing more cost-effective, long-acting antihypertensive drugs, and raising the reimbursement ratio were associated with a better treatment adherence in Chinese patients with hypertension.
Collapse
Affiliation(s)
- Bin Cui
- School of Public Health, Peking University, Beijing100191, People’s Republic of China
| | - Zhaohui Dong
- Human Resources and Social Security, Chinese Academy of Labour and Social Security, Beijing, 100029, People’s Republic of China
| | - Mengmeng Zhao
- School of Pharmaceutical Science and Technology, School of Pharmacy, Tianjin University, Tianjin, 300072, People’s Republic of China
| | - Shanshan Li
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Hua Xiao
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Zhitao Liu
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
- Correspondence: Xiaowei Yan Peking Union Medical College Hospital, Beijing100730, People’s Republic of China Email
| |
Collapse
|
19
|
Rea F, Corrao G, Merlino L, Mancia G. Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension. Eur Heart J 2019; 39:3654-3661. [PMID: 30060044 DOI: 10.1093/eurheartj/ehy420] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/03/2018] [Indexed: 02/07/2023] Open
Abstract
Aims Guidelines support use of drug combinations in most hypertensive patients, and recently treatment initiation with two drugs has been also recommended. However, limited evidence is available on whether this leads to greater cardiovascular (CV) protection compared to initial monotherapy. Methods and results Using the healthcare utilization database of the Lombardy Region (Italy), the 44 534 residents of the region (age 40-80 years) who in 2010 started treatment with one antihypertensive drug (n = 37 078) or a two-drug fixed-dose combination (FDC, n = 7456) were followed for 1 year after treatment initiation to compare the risk of hospitalization for CV disease associated with the two treatment strategies. To limit the confounding associated with non-randomized between-group comparisons, data were also analysed by: (i) matching the two groups by the high-dimensional propensity score (HDPS) and (ii) comparing, in patients experiencing one or more CV events (n = 2212), the CV event incidence during subperiods in which patients were prescribed mono- or FDC therapy (self-controlled case series design). Compared to initial monotherapy, patients on initial FDC therapy showed a reduced 1 year risk of hospitalization for any CV event (-21%, P < 0.01). This was the case also when groups were compared according to the HDPS analysis (-15%, P < 0.05). Finally, in patients experiencing CV events, the event incidence was much less when, during the 1 year follow-up, they were under FDC therapy than under monotherapy (-56%, P < 0.01). The reduced risk of hospitalization was always significant for ischaemic heart disease and new onset atrial fibrillation, and included hospitalization for cerebrovascular disease and heart failure when monotherapy and FDC therapy were compared within patients. Conclusion In a real-life setting, a comparison of the incidence of early CV events during antihypertensive monotherapy and FDC shows that the latter strategy leads to a more effective CV protection. This scores in favour of a two-drug FDC strategy as first step in the hypertensive population.
Collapse
Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca Milan, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca Milan, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca Milan, Milan, Italy.,Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | | |
Collapse
|
20
|
Seravalle G, Dell’Oro R, Grassi G. Baroreflex activation therapy systems: current status and future prospects. Expert Rev Med Devices 2019; 16:1025-1033. [DOI: 10.1080/17434440.2019.1697230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gino Seravalle
- Cardiology Department, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | | | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milano-Monza, Italy
| |
Collapse
|
21
|
Marinier K, Macouillard P, de Champvallins M, Deltour N, Poulter N, Mancia G. Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink. Pharmacoepidemiol Drug Saf 2019; 28:1572-1582. [PMID: 31482621 PMCID: PMC6916605 DOI: 10.1002/pds.4884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022]
Abstract
Purpose To compare the effectiveness on blood pressure (BP) of initial two‐drug therapy versus monotherapy in hypertensive patients. Methods Using the Clinical Practice Research Datalink, linked with Hospital Episode Statistics and Office for National Statistics, we identified a cohort of adults with uncontrolled hypertension, initiating one or two antihypertensive drug classes between 2006 and 2014. New users of two drugs and monotherapy were matched 1:2 by propensity score. Main exposure was “as‐treated,” ie, until first regimen change. Primary and secondary endpoints were systolic and diastolic BP control and major adverse cardiovascular event (MACE), respectively. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard models. Results Of 54 523 eligible patients, 3256 (6.0%) were initiated to a two‐drug combination. Of these, 2807 were matched to 5614 monotherapy users. Mean exposure duration was 12.7 months, with 76.5% patients changing their initial regimen. Two‐drug therapy was associated with a clinically significant BP control increase in all hypertensive patients (HR = 1.17 [95%CI: 1.09‐1.26]), more so in patients with grade 2‐3 hypertension (HR = 1.28 [1.17‐1.41]). An increase of 27% in BP control (HR = 1.27 [1.08‐1.49]) was observed in patients initiating an ACEi+CCB combination compared with initiators of either single class. No significant association was found between two‐drug therapy and MACE. Several sensitivity analyses confirmed the main findings. Conclusions Few patients initiated therapy with two drugs, reflecting UK guidelines' recommendation to start with monotherapy. This study supports the greater effectiveness of two‐drug therapy as the initial regimen for BP control.
Collapse
Affiliation(s)
- Karine Marinier
- Department of Pharmacoepidemiology and Real World Evidence, Servier, Suresnes, France
| | | | | | - Nicolas Deltour
- Department of Pharmacoepidemiology and Real World Evidence, Servier, Suresnes, France
| | - Neil Poulter
- School of Public Health, Imperial College London, London, UK
| | | |
Collapse
|
22
|
Sedykh DY, Kazantsev AN, Tarasov RS, Kashtalap VV, Volkov AN, Grachev KI, Shabayev AR, Barbarash OL. [Predictors of Progressive Course of Multifocal Atherosclerosis in Patients With Myocardial Infarction]. ACTA ACUST UNITED AC 2019; 59:36-44. [PMID: 31131766 DOI: 10.18087/cardio.2019.5.10257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Determination of clinical and instrumental predictors of progressive course of multifocal atherosclerosis (MFA) in patients one year after myocardial infarction (MI), initially having hemodynamically insignificant stenoses of carotid arteries. MATERIALS AND METHODS From database of patients with acute coronary syndrome treated in the Kemerovo Regional Clinical Cardiac Dispensary in 2009-2010 we selected for this study 141 patients with verified diagnosis of MI and hemodynamically insignificant lesions in the internal carotid artery (ICA) (stenosis up ≤ 55 %). All patients had coronary atherosclerosis verified on coronary angiography at admission because of MI. A multivariate analysis of possible predictors of the progressive course of multifocal atherosclerosis was made based on assessment of the development of cardiovascular complications (CVC) (death, MI, stroke and transient cerebral circulatory attacks [TIA]), as well as revascularizations and negative dynamics of parameters of color duplex scanning (CDS) of ICA during one year after MI. RESULTS One year after MI the overall incidence of CVC was 16.3 % (n=23). Structure of registered events was as follows: death from MI 7.1 % (n=10), deaths from stroke 2.1 % (n=3) and other causes 2.1 % (n=3), non-fatal MI 5.0 % (n=7), non-fatal stroke / TIA 2.1 % (n=3), carotid revascularization 2.8 % (n=4), coronary revascularization 14.9 % (n=21). CDC of ICAs was repeated in 125 patients. There were 17 (13.6 %) cases of progression of carotid atherosclerosis in the form of de novo bilateral stenoses in 14 (11.2 %) patients, stenoses in the left and right ICA 1 patient and 2 patients, respectively. The following predictors of progression of atherosclerosis of cerebral arteries were identified: family history of cardiovascular diseases (CVD),ICA stenosis ≥45 %, baseline circular atherosclerotic plaque (ASP). Predictors of high risk of stroke were family history of CVD, history of stroke,ICA stenosis ≥45 %, heterogeneous hypoechoic ASP. As predictors of lethal outcome, we identified history of MI, high functional class of angina preceding the index MI, severe coronary vascular bed involvement (SYNTAX score >23), presence of any bilateral atherosclerotic lesion in ICAs, and heterogeneous hypoechoic ASP. Assessment of the contribution of adherence to therapy in the prognosis 1 year after hospital discharge was fulfilled in 125 alive patients. It allowed to conclude that patients with progression of atherosclerosis and nonfatal CVC were characterized by insufficient adherence to standard therapy. CONCLUSION Predictors of the progressive course of multifocal atherosclerosis during one year after MI were identified in this study. It is necessary to strengthen therapeutic and preventive measures aimed at minimization of the impact of these factors in this category of patients.
Collapse
Affiliation(s)
- D Yu Sedykh
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Clinical Cardiology Dispensary
| | - A N Kazantsev
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Clinical Cardiology Dispensary
| | - R S Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
| | - A N Volkov
- Kemerovo Regional Clinical Cardiology Dispensary
| | | | - A R Shabayev
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Clinical Cardiology Dispensary
| | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
| |
Collapse
|
23
|
Gilyarevskiy SR, Golshmid MV, Zaharova GY, Kuzmina IM, Sinitsina II. A Flexible Regimen of Combination Antihypertensive Therapy for Lower Blood Pressure to the Lower Target Level. Viewpoint of Cardiologist and Clinical Pharmacologist. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-2-265-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - M. V. Golshmid
- Russian Medical Academy of Continuing Professional Education
| | - G. Yu. Zaharova
- Russian Medical Academy of Continuing Professional Education
| | - I. M. Kuzmina
- Sklifosovsky Research Institute of Emergency Medicine
| | - I. I. Sinitsina
- Russian Medical Academy of Continuing Professional Education
| |
Collapse
|
24
|
Rea F, Corrao G, Merlino L, Mancia G. Initial Antihypertensive Treatment Strategies and Therapeutic Inertia. Hypertension 2019; 72:846-853. [PMID: 30354712 DOI: 10.1161/hypertensionaha.118.11308] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In many hypertensive patients, treatment is not upgraded despite lack of blood pressure control because of therapeutic inertia. Information is limited, however, on the extent of this phenomenon in real-life medicine. We studied 125 635 patients (age 40-85 years) from the Lombardy region (Italy) who started antihypertensive treatment with 1 drug (n=100 982) or a 2-drug fixed-dose or free combination (n=24 653). A log-binomial regression model was used to estimate the prevalence ratio of combination therapy in relation to the initial treatment strategy. In the initial monotherapy group, patients under drug combinations were 22%, 27%, 32%, and 36% at 6 months, 1, 2, and 3 years later. In the initial combination treatment group, the corresponding percentages were 85%, 82%, 79%, and 78%. This translated into a markedly greater covariate-adjusted propensity of being under a multidrug prescription throughout the follow-up: 3.92 (95% CI, 3.84-4.00) after 6 months and 3.18 (3.12-3.25), 2.56 (2.51-2.60), and 2.23 (2.19-2.27) after 1, 2 and 3 years of treatment. In a propensity score analysis, initial 2-drug combination treatment was also associated with significant reductions in the risk of death (-20%, 11% to 28%) and hospitalization for cardiovascular events (-16%, 10% to 21%) compared with initial monotherapy. Thus, in real life, a large number of patients prescribed initial monotherapy fails to move to combination treatment, as recommended by guidelines. This implies that therapeutic inertia frequently prevents proper treatment uptitration, thereby playing a major role in the low rate of hypertension control that exists worldwide.
Collapse
Affiliation(s)
- Federico Rea
- From the National Centre for Healthcare Research and Pharmacoepidemiology (F.R., G.C., L.M.), University of Milano-Bicocca, Italy.,Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Giovanni Corrao
- From the National Centre for Healthcare Research and Pharmacoepidemiology (F.R., G.C., L.M.), University of Milano-Bicocca, Italy.,Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Luca Merlino
- From the National Centre for Healthcare Research and Pharmacoepidemiology (F.R., G.C., L.M.), University of Milano-Bicocca, Italy.,Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy (L.M.)
| | - Giuseppe Mancia
- University of Milano-Bicocca, Milan, Italy (G.M.); and Policlinico di Monza, Italy (G.M.)
| |
Collapse
|
25
|
Affiliation(s)
| | - Federico Rea
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Guido Grassi
- Department of Medicine and Surgery Clinica Medica (G.G.), University of Milano-Bicocca, Italy
- IRCCS Mutimedica, Sesto San Giovanni, Milan, Italy (G.G.)
| |
Collapse
|
26
|
Ah YM, Shin J, Lee JY. The association of angiotensin receptor blocker-based combination therapy with persistence and adherence in newly treated, uncomplicated hypertensive patients. Patient Prefer Adherence 2019; 13:241-248. [PMID: 30774320 PMCID: PMC6362963 DOI: 10.2147/ppa.s195423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We compared treatment adherence and persistence during treatment with an angiotensin receptor blocker (ARB)-based single pill combination (SPC) and free equivalent combination (FEC) and between SPCs of an ARB with a thiazide diuretic (TD) and an ARB with a calcium channel blocker (CCB) as initial treatment in uncomplicated hypertensive patients who received pre-packaged medications from the pharmacy. PATIENTS AND METHODS Uncomplicated hypertensive patients who started combination treatment consisting of ARB and either TD or CCB were identified from a Korean national claims database. We used propensity score matching to construct two pairs of cohorts: SPC and FEC cohorts (20,175 patients per cohort) and SPC cohorts of ARB + TD and ARB + CCB (45,253 patients per cohort). We compared adherence measured via the medication possession ratio as well as overall 1-year and initial treatment persistence. RESULTS Compared with the FEC cohort, the SPC cohort had significantly higher medication adherence (OR 1.31, 95% CI 1.25-1.37), overall persistence (HR 1.33, 95% CI 1.28-1.38), and initial treatment persistence (HR 1.61, 95% CI 1.56-1.64). Neither the rate of medication adherence nor the rate of treatment persistence differed significantly between the ARB + TD and ARB + CCB cohorts. However, the ARB + CCB cohort had a significantly higher rate of initial treatment persistence than did the ARB + TD cohort (HR 1.12, 95% CI 1.10-1.14). CONCLUSION Our data suggest that, compared with FEC therapy, initiating an ARB-based SPC therapy may increase adherence and persistence in patients with uncomplicated hypertension who also receive pre-packaged medication from the pharmacy. Although using an ARB + CCB SPC may improve initial treatment persistence, it does not increase adherence or overall persistence when compared with an ARB + TD SPC.
Collapse
Affiliation(s)
- Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea,
| |
Collapse
|
27
|
Treatment patterns and adherence to antihypertensive combination therapies in Japan using a claims database. Hypertens Res 2018; 42:249-256. [PMID: 30443023 PMCID: PMC8075995 DOI: 10.1038/s41440-018-0127-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 01/17/2023]
Abstract
Fixed-dose combinations (FDCs) for blood pressure control can simplify prescribing, improve medication adherence, and be cost-effective. In Japan, real-world data about the class effects of antihypertensive drugs on medication adherence are limited. Using the nationwide database of medical health claims from Diagnosis Procedure Combination hospitals, treatment patterns and adherence were analyzed for 47,891 patients prescribed antihypertensive medication between April 2014 and March 2015. Adherence was assessed by the proportion of days covered (expressed as % PDC). Patients were prescribed a mean of 2.0 ± 1.0 antihypertensive drugs and 2.4 ± 1.7 pills for their index prescription. Mean adherence overall was 91.5% PDC and was inversely correlated with the number of antihypertensive drugs or pills prescribed on the index date. Mean % PDC was significantly higher (all P < 0.0001) for CCB + ARB versus ARB + thiazide diuretic combinations and for CCB + ARB + β-blocker versus CCB + ARB + thiazide diuretic combinations. Adherence was significantly higher (P < 0.0001) for FDC (CCB + ARB) versus corresponding single-drug combinations, but not for other comparisons of FDCs versus single-drug combinations. On the other hand, FDCs were not always used effectively; specifically, FDCs were frequently used concomitantly with a single agent(s) from the same drug class(es) as the FDC. From the results of our study, no clear differences were observed in medication adherence according to the presence or absence of FDC formulations, and there were cases in which FDCs were not being utilized effectively to simplify prescribing.
Collapse
|
28
|
Trenkwalder P. [Modern stepped care treatment of arterial hypertension]. MMW Fortschr Med 2018; 160:42-46. [PMID: 30406530 DOI: 10.1007/s15006-018-1087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
29
|
The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
30
|
Mahmoudpour SH, Asselbergs FW, Souverein PC, de Boer A, Maitland-van der Zee AH. Prescription patterns of angiotensin-converting enzyme inhibitors for various indications: A UK population-based study. Br J Clin Pharmacol 2018; 84:2365-2372. [PMID: 29943849 DOI: 10.1111/bcp.13692] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/04/2018] [Accepted: 06/14/2018] [Indexed: 01/16/2023] Open
Abstract
AIM Angiotensin-converting enzyme inhibitors (ACEIs) are widely prescribed for several cardiovascular indications. This study investigated patterns of ACEI use for various indications. METHODS A descriptive, retrospective population-based study was conducted using data from the UK Clinical Practice Research Datalink. Patients starting ACEIs (2007-2014) were selected and ACEI indications were retrieved from electronically recorded medical records. Stratified by indication, we distinguished between persistent and nonpersistent ACEI use, considering a 6-month interval between two prescription periods as a maximum for persistent use. Five-year persistence rates for various indications were calculated using the Kaplan-Meier method and compared in a log-rank test. Nonpersistent users were subdivided into three groups: (i) stop; (ii) restart; and (iii) switch to an angiotensin II-receptor blocker. Patients who received ACEIs for hypertension who switched to other classes of antihypertensive medications were further investigated. RESULTS In total, 254 002 ACEI initiators were identified with hypertension (57.6%), myocardial infarction (MI; 4.2%), renal disease (RD; 3.7%), heart failure (HF; 1.5%), combinations of the above (17.2%) or none of the above (15.8%). Five-year persistence rates ranged from 43.2% (RD) to 68.2% (MI; P < 0.0001). RD and HF patients used ACEIs for the shortest time (average 23.6 and 25.0 months, respectively). For the nonpersistent group, the percentage of switchers to angiotensin II-receptor blockers ranged from 27.6% (RD) to 42.2% (MI) and the restarters ranged from 15.0% (HF) to 18.1% (group without indication). CONCLUSIONS Depending on the indication, there are various rates of ACEI nonpersistence. Patients with RD are most likely to discontinue treatment.
Collapse
Affiliation(s)
- Seyed Hamidreza Mahmoudpour
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,Institute for Medical Biostatistics, Epidemiology, and Informatics (IMBEI), Department of Biometry and Bioinformatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, the Netherlands.,Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
31
|
Tilea I, Petra D, Voidazan S, Ardeleanu E, Varga A. Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania. Patient Prefer Adherence 2018; 12:625-635. [PMID: 29731610 PMCID: PMC5923249 DOI: 10.2147/ppa.s162965] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. PATIENTS AND METHODS A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. RESULTS The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001). CONCLUSION This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.
Collapse
Affiliation(s)
- Ioan Tilea
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Dorina Petra
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
- Correspondence: Dorina Petra, Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, 38, Gheorghe Marinescu Street, Tirgu Mures 540319, Mures, Romania, Tel +40 740 19 4122, Fax +40 265 21 1011, Email
| | - Septimiu Voidazan
- Department M2-Functional and Complementary Sciences, Epidemiology Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Elena Ardeleanu
- Department XVI-Balneology, Medical Rehabilitation and Rheumatology, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Timisoara, Timis, Romania
| | - Andreea Varga
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| |
Collapse
|
32
|
Reply. J Hypertens 2017; 35:2551-2552. [PMID: 29095235 DOI: 10.1097/hjh.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Drug adherence in hypertension. Pharmacol Res 2017; 125:142-149. [DOI: 10.1016/j.phrs.2017.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 01/13/2023]
|
34
|
Jacob L, Adam-Schnepf L, Kostev K. Persistence with Antihypertensive Drugs in Patients with Hypertension and Dementia in Germany. J Alzheimers Dis 2017; 60:505-510. [DOI: 10.3233/jad-170452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | | | | |
Collapse
|
35
|
Choi KH, Yu YM, Ah YM, Chang MJ, Lee JY. Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:232. [PMID: 28836946 PMCID: PMC5571581 DOI: 10.1186/s12872-017-0665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the medication-taking behavior in very elderly hypertensive patients. The aim of this study was to evaluate the persistence and adherence with antihypertensive agents in treatment-naïve patients, along with other related factors, according to age. METHODS Adult (19-64 years), elderly (65-79 years), and very elderly (≥80 years) uncomplicated hypertensive patients starting antihypertensive monotherapy were identified from the National Health Insurance claims database. The first-year treatment persistence and adherence rates measured using the medication possession ratio were assessed and compared in these three age cohorts. RESULTS After propensity score matching, three age cohorts with 6689 patients each were assembled from 228,925 uncomplicated hypertensive patients who began antihypertensive monotherapy in 2012. The treatment persistence and adherence rates over the first year were the lowest in the very elderly (59.5% and 62.8%, respectively) and highest in the elderly (65.2% and 67.9%, respectively) patients among the three age cohorts (p < 0.001). The adjusted risk for treatment non-persistence was significantly higher in the very elderly (adjusted hazard ratio, 1.20; 95% confidence interval, 1.13-1.27) compared with the elderly. Having more comorbidities, being a beneficiary of medical aid, and having a diagnosis of dementia were unique positive predictors for treatment persistence in the very elderly, along with common predictors such as female sex, dyslipidemia, and an initially chosen antihypertensive therapeutic class other than beta blockers and thiazide diuretics. CONCLUSIONS Very elderly patients were less likely to continue antihypertensive therapy over the first year compared with their younger counterparts. Our findings suggest that a low comorbidity index and lack of medical aid support negatively affect the treatment persistence in this population.
Collapse
Affiliation(s)
- Kyung Hee Choi
- College of Pharmacy, Sunchon National University, 255 Jungang-ro, Suncheon, Jeollanam-do, 57922, South Korea.,College of Pharmacy, Chonnam National University, Gwang-Ju, 61186, South Korea
| | - Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea
| | - Min Jung Chang
- College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, 21983, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea.
| |
Collapse
|
36
|
|
37
|
|
38
|
Fici F, Seravalle G, Koylan N, Nalbantgil I, Cagla N, Korkut Y, Quarti-Trevano F, Makel W, Grassi G. Follow-up of Antihypertensive Therapy Improves Blood Pressure Control: Results of HYT (HYperTension survey) Follow-up. High Blood Press Cardiovasc Prev 2017; 24:289-296. [PMID: 28497339 DOI: 10.1007/s40292-017-0208-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/02/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Although improved during the past few years, blood pressure control remains sub optimal. AIM The impact of follow-up assessment on blood pressure control was evaluated in a group of patients of the HYT (HYperTension survey), treated with a combination of different dihydropyridine calcium-channel blockers (CCBs regimen) and inhibitors of renin-angiotensin-aldosterone system (RAAS) and with uncontrolled blood pressure. This was obtained assessing (a) the rate of blood pressure control at 3 and 6 months of follow-up in the whole group of patients, (b) the rate of blood pressure control and the average blood pressure values in subjects treated with different DHP-CCBs regimen. METHODS From the 4993 patients with uncontrolled blood pressure, (BP ≥ 140/90 or ≥140/85 in patients with diabetes), 3729 (mean age 61.2 ± 11.5 years), maintained CCBs regimen combined wih RAAS blockers and were evaluated at 3 and 6 months follow-up. At each visit BP (semiautomatic device, Omron-M6, 3 measurements), heart rate, adverse events and treatment persistence were collected. RESULTS At 1st and 2nd follow-up the rate of controlled BP was 63.5 and 72.8% respectively (p < 0.05 vs 35.3% at baseline), whereas in diabetes was 32.5 and 37.9% respectively (p < 0.05 vs 20% at baseline). No differences in heart rate were observed. No differences in control rate were observed between the different CCBs regimen. The incidence of drugs related adverse events was 3.6%. CONCLUSIONS These findings provide evidence that: (a) the follow-up of hypertensive patients under therapy increase the rate of blood pressure control; (b) there is no significant difference in the antihypertensive effect between different CCBs regimen;
Collapse
Affiliation(s)
- F Fici
- Clinica Medica, Università Milano Bicocca, via Pergolesi 33, Monza-Milan, 20052, Italy
| | - G Seravalle
- Cardiology Department, Istituto Auxologico Italiano, IRCCS S. Luca Hpt, Milan, Italy
| | - N Koylan
- Anadolu Saglik Merkezi, Istanbul, Turkey
| | - I Nalbantgil
- Department of Cardiology, Ege University, Izmir, Turkey
| | - N Cagla
- Düzen Labaratuvarları, Ankara, Turkey
| | - Y Korkut
- Primary Care Department, Dumlupinar University, Kutahyta, Turkey
| | - F Quarti-Trevano
- Clinica Medica, Università Milano Bicocca, via Pergolesi 33, Monza-Milan, 20052, Italy
| | - W Makel
- Clinical Research Facilities International B.V., Schaijk, The Netherlands
| | - G Grassi
- Clinica Medica, Università Milano Bicocca, via Pergolesi 33, Monza-Milan, 20052, Italy.
- IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
| |
Collapse
|
39
|
Blood pressure control in hypertension. Pros and cons of available treatment strategies. J Hypertens 2017; 35:225-233. [DOI: 10.1097/hjh.0000000000001181] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Boström KB, Manhem K, Hjerpe P, Wettermark B. Persistence to antihypertensive drug classes: A cohort study using the Swedish Primary Care Cardiovascular Database (SPCCD). Medicine (Baltimore) 2016; 95:e4908. [PMID: 27749548 PMCID: PMC5059050 DOI: 10.1097/md.0000000000004908] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim was to study persistence to, and switching between, antihypertensive drug classes and to determine factors associated with poor persistence.This was an observational cohort study. The Swedish Primary Care Cardiovascular Database includes data from medical records, socioeconomic data, filled prescriptions, and hospitalizations from national registries for 75,000 patients with hypertension. Patients included in the study were initiated on antihypertensive drug treatment in primary healthcare in 2006 to 2007. We defined class persistence as the proportion remaining on the initial drug class, including 30 days of gap. Patients with a filled prescription of another antihypertensive drug class after discontinuation of the initial drug, including 30 days of gap, were classified as switchers. Persistence to the various drug classes were compared with that for diuretics.We identified 4997 patients (mean age 60 ± 12 years in men and 63 ± 13 years in women). Out of these, 95 (2%) filled their first prescription for fixed combination therapy and 4902 (98%) for monotherapy, including angiotensin converting enzyme inhibitors (37%), angiotensin receptor blockers (4%), beta blockers (21%), calcium channel blockers (8%), and diuretics (28%). Persistence to the initial drug class was 57% after 1 year and 43% after 2 years. There were no differences in persistence between diuretics and any of the other antihypertensive drug classes, after adjustment for confounders. Discontinuation (all adjusted) was more common in men (P = 0.004), younger patients (P < 0.001), those with mild systolic blood pressure elevation (P < 0.001), and patients born outside the Nordic countries (P < 0.001). Among 1295 patients who switched drug class after their first prescription, only 21% had a blood pressure recorded before the switch occurred; and out them 69% still had high blood pressures.In conclusion, there appears to be no difference in drug class persistence between diuretics and other major antihypertensive drug classes, when factors known to be associated with poor persistence are taken into account.
Collapse
Affiliation(s)
- Miriam Qvarnström
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
- Correspondence: Miriam Qvarnström, Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet, Solna, T2, Karolinska University Hospital, SE-171 76 Stockholm, Sweden (e-mail: )
| | - Thomas Kahan
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet
| | - Helle Kieler
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
| | - Lena Brandt
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Stockholm
| | | | - Karin Manhem
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Per Hjerpe
- Närhälsan R&D Primary Care, R&D-Center Skaraborg, Skövde
| | - Björn Wettermark
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
41
|
Belleudi V, Di Martino M, Cascini S, Kirchmayer U, Pistelli R, Formoso G, Fusco D, Davoli M, Agabiti N. The impact of adherence to inhaled drugs on 5-year survival in COPD patients: a time dependent approach. Pharmacoepidemiol Drug Saf 2016; 25:1295-1304. [PMID: 27396695 PMCID: PMC5129577 DOI: 10.1002/pds.4059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/02/2016] [Accepted: 06/08/2016] [Indexed: 12/02/2022]
Abstract
Purpose Whether inhaled medications improve long‐term survival in Chronic Obstructive Pulmonary Disease (COPD) is an open question. The purpose of this study is to assess the impact of adherence to inhaled drug use on 5‐year survival in COPD. Methods A population‐based cohort study in three Italian regions was conducted using healthcare linked datasets (hospitalization, mortality, drugs). Individuals (45+ years) discharged after COPD exacerbation in 2006–2009 were enrolled. Inhaled drug daily use during 5‐year follow‐up was determined through Proportion of Days Covered on the basis of Defined Daily Doses. Five levels of time‐dependent exposure were identified: (i) long‐acting β2 agonists and inhaled corticosteroids (LB/ICS) regular use; (ii) LB/ICS occasional use; (iii) LB regular use; (iv) LB occasional use; and (v) respiratory drugs other than LB. Cox regression models adjusted for baseline (socio‐demographic, comorbidities, drug use) and time‐dependent characteristics (COPD exacerbations, cardiovascular hospitalizations, cardiovascular therapy) were performed. Results A total of 12 124 individuals were studied, 46% women, mean age 73,8 years. Average follow‐up time 2,4 year. A total of 3415 subjects died (mortality rate = 11.9 per 100 person years). In comparison to LB/ICS regular use, higher risks of death for all remaining treatments were found, the highest risk for respiratory drugs other than LB category (HR = 1.63, 95%CI 1.43–1.87). Patients with regular LB use had higher survival than those with LB/ICS occasional use (HR = 0.89, 95%CI 0.79–0.99). Conclusions These findings support clinical guidelines and recommendations for the regular use of inhaled drugs to improve health status and prognosis among moderate–severe COPD patients. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Silvia Cascini
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Riccardo Pistelli
- Department of Respiratory Physiology, Catholic University, Roma, Italy
| | - Giulio Formoso
- Emilia-Romagna Regional Health and Social Care Agency, Bologna, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy.
| | | |
Collapse
|
42
|
Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Agabiti Rosei E, Cherubini A, Redon J, Grodzicki T, Dominiczak A, Strandberg T, Mancia G. An Expert Opinion From the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects. Hypertension 2016; 67:820-5. [DOI: 10.1161/hypertensionaha.115.07020] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Christopher J. Bulpitt
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Mirko Petrovic
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Andrea Ungar
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Enrico Agabiti Rosei
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Antonio Cherubini
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Josep Redon
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Tomasz Grodzicki
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Anna Dominiczak
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Timo Strandberg
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Giuseppe Mancia
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| |
Collapse
|
43
|
Gender Differences in Antihypertensive Treatment: Myths or Legends? High Blood Press Cardiovasc Prev 2016; 23:105-13. [DOI: 10.1007/s40292-016-0148-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022] Open
|
44
|
Cadeddu C, Franconi F, Cassisa L, Campesi I, Pepe A, Cugusi L, Maffei S, Gallina S, Sciomer S, Mercuro G. Arterial hypertension in the female world. J Cardiovasc Med (Hagerstown) 2016; 17:229-36. [DOI: 10.2459/jcm.0000000000000315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
45
|
Schmieder RE, Ott C, Schmid A, Friedrich S, Kistner I, Ditting T, Veelken R, Uder M, Toennes SW. Adherence to Antihypertensive Medication in Treatment-Resistant Hypertension Undergoing Renal Denervation. J Am Heart Assoc 2016; 5:e002343. [PMID: 26873693 PMCID: PMC4802436 DOI: 10.1161/jaha.115.002343] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adherence to medication has been repeatedly proposed to represent a major cause of treatment-resistant hypertension (TRH); however, treatment decisions such as treating TRH with renal denervation depend on accurate judgment of adherence. We carefully analyzed adherence rates to medication before and after renal denervation and its effect on blood pressure (BP) control. METHODS AND RESULTS Eighty patients with TRH were included in 2 prospective observational studies that assessed the difference of potential antihypertensive and nephroprotective effects of renal denervation. To compare prescribed with actual medication intake (representing a measure of adherence), we analyzed urine samples collected at baseline and at 6 months after renal denervation for antihypertensive compounds or metabolites (by liquid chromatography-mass spectrometry). In addition to office BP, 24-hour ambulatory BP and central hemodynamics (central systolic pressure, central pulse pressure) were assessed. Informed consent for analyses of urine metabolites was obtained from 79 of 80 patients. Actual intake of all antihypertensive drugs was detected at baseline and at 6 months after renal denervation in 44 (56%) and 52 (66%) patients, respectively; 1 drug was missing in 22 (28%) and 17 (22%) patients, respectively, and ≥2 drugs were missing in 13 (16%) and 10 (13%) patients, respectively. At baseline, 24-hour ambulatory BP (P=0.049) and central systolic BP (P=0.012) were higher in nonadherent patients. Adherence did not significantly change overall (McNemar-Bowker test, P=0.362). An increase in adherence was observed in 21 patients, and a decrease was observed in 11 patients. The decrease in 24-hour ambulatory BP was not different in those with stable adherence 6 months after renal denervation (n=41, -7±13 mm Hg) compared with those with increased adherence (n=21, -10±13 mm Hg) and decreased adherence (n=11, -7±14 mm Hg) (P>0.20). Our study is limited by the relatively small sample size and potentially by the specific health environment of our university center (Northern Bavaria, Germany). CONCLUSIONS Nonadherence to medication among patients with TRH was relatively low: ≈1 of 6 patients with TRH did not take ≥2 of the prescribed drugs. Adherence pattern did not change significantly after renal denervation and had no impact on the overall observed BP changes, supporting the concept that renal denervation is an effective treatment in patients with TRH. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00888433, NCT01442883 and NCT01687725.
Collapse
Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Axel Schmid
- Department of Diagnostic Radiology, University Hospital, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefanie Friedrich
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Iris Kistner
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Tilmann Ditting
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Veelken
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Department of Diagnostic Radiology, University Hospital, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan W Toennes
- Department of Forensic Toxicology, Institute of Legal Medicine, Frankfurt, Germany
| |
Collapse
|
46
|
Abstract
Treatment-resistant hypertension (TRH) is an increasingly common and clinically challenging hypertension phenotype associated with adverse impact on cardiovascular events and death. Recent evidence, although limited, suggests that TRH may also adversely affect health-related quality of life (HrQoL) and other patient-reported outcomes. However, the precise mechanisms for this link remain unknown. A number of recent studies focusing on both the general hypertensive population and those with TRH suggest that patient awareness of difficult-to-control blood pressure, chronically elevated blood pressure levels, and the use of aggressive medication regimens with attendant cumulative adverse effects may play significant roles. This review summarizes the existing literature on HrQoL in persons with TRH, highlights literature from the general hypertensive population with relevance to TRH, and discusses important remaining questions regarding HrQoL in persons with TRH.
Collapse
Affiliation(s)
- Nicholas W Carris
- Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, PO Box 100486, Gainesville, FL, 32610, USA,
| | | |
Collapse
|
47
|
Truong VT, Moisan J, Kröger E, Langlois S, Grégoire JP. Persistence and compliance with newly initiated antihypertensive drug treatment in patients with chronic kidney disease. Patient Prefer Adherence 2016; 10:1121-9. [PMID: 27382260 PMCID: PMC4922779 DOI: 10.2147/ppa.s108757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease initiating an antihypertensive drug (AH) treatment must persist and comply with it to slow disease progression and benefit from the reduction of cardiovascular morbidity and mortality. OBJECTIVES This study evaluates the persistence and compliance with AH treatment and identifies the associated factors among chronic kidney disease patients who initiated AH treatment. METHODS A population-based cohort study using Quebec administrative data was conducted. Patients who still take any AH 1 year after initiation were considered persistent. Of these patients, those who had ≥80% of days covered with an AH in the year after initiation were considered compliant. Factors associated with persistence and compliance were identified using a modified Poisson regression. RESULTS Of the 7,119 eligible patients, 78.8% were persistent, 87.7% of whom were compliant with their AH treatment. Compared with patients on diuretic monotherapy, those who initially used angiotensin-converting enzyme inhibitor monotherapy, angiotensin II receptor blocker monotherapy, calcium channel blocker monotherapy, β-blocker monotherapy, or multidrug therapy were more likely to be persistent. In contrast, individuals who visited their physicians ≥17 times were less likely to be persistent than those who visited between 0 and 8 times. The patients who were more likely to be compliant had initially used an angiotensin-converting enzyme inhibitor, β-blocker, calcium channel blocker, or multitherapy as opposed to a diuretic. CONCLUSION A year after initiating AH treatment, nearly a third of chronic kidney disease patients were either not taking an AH or had not been compliant. Factors associated with persistence and compliance could help identify patients who need help in managing their AH treatment.
Collapse
Affiliation(s)
- Viet Thanh Truong
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
| | - Edeltraut Kröger
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
- Center of Excellence on Aging of Québec
| | | | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University
- Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center
- Correspondence: Jean-Pierre Grégoire, Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, Canada G1S 4L8, Tel +1 418 682 7511 ext 84664, Fax +1 418 682 7949, Email
| |
Collapse
|
48
|
Ah YM, Lee JY, Choi YJ, Kim B, Choi KH, Kong J, Oh JM, Shin WG, Lee HY. Persistence with Antihypertensive Medications in Uncomplicated Treatment-Naïve Patients: Effects of Initial Therapeutic Classes. J Korean Med Sci 2015; 30:1800-6. [PMID: 26713055 PMCID: PMC4689824 DOI: 10.3346/jkms.2015.30.12.1800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Abstract
We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.
Collapse
Affiliation(s)
- Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Yun-Jung Choi
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Baegeum Kim
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Kyung Hee Choi
- College of Pharmacy, Sunchon National University, Suncheon, Korea
| | - Jisun Kong
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Jung Mi Oh
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Wan Gyoon Shin
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
49
|
Comparison of single-pill strategies first line in hypertension: perindopril/amlodipine versus valsartan/amlodipine. J Hypertens 2015; 33:1115-6. [PMID: 25909706 DOI: 10.1097/hjh.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
50
|
Corrao G, Mancia G. Generating Evidence From Computerized Healthcare Utilization Databases. Hypertension 2015; 65:490-8. [DOI: 10.1161/hypertensionaha.114.04858] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Giovanni Corrao
- From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C.); Department of Clinical Medicine (G.M.), University of Milano-Bicocca, Milan, Italy; and IRCCS, Istituto Auxologico Italiano, Milan, Italy (G.M.)
| | - Giuseppe Mancia
- From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C.); Department of Clinical Medicine (G.M.), University of Milano-Bicocca, Milan, Italy; and IRCCS, Istituto Auxologico Italiano, Milan, Italy (G.M.)
| |
Collapse
|