Impact of once- or twice-daily dosing frequency on adherence to chronic cardiovascular disease medications: A meta-regression analysis
Related Experiment Video
Updated: Mar 21, 2026
Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
Published on: November 8, 2013
Erin R Weeda1, Craig I Coleman1, Colleen A McHorney2
1University of Connecticut School of Pharmacy, Storrs, CT, USA; University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA.
Insights
Patients with cardiovascular disease show better adherence to once-daily medications compared to twice-daily regimens. Simplifying medication schedules can improve patient compliance and treatment outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Cardiovascular diseases (CVD) often necessitate chronic medication regimens.
- Many CVD medications require multiple daily doses, potentially impacting patient adherence.
Purpose of the Study:
- To evaluate the impact of once-daily versus twice-daily dosing on patient adherence to chronic CVD medications.
Main Methods:
- Systematic literature search of Medline and Embase (1986-2015) for prospective studies.
- Inclusion of studies electronically measuring adherence to oral CVD medications taken 1-2 times daily for at least four weeks.
- Meta-regression analysis to assess the effect of dosing frequency on regimen and timing adherence.
Main Results:
- 26 studies with 2285 patients were analyzed.
- Lower unadjusted adherence rates were observed for twice-daily (73.8% regimen, 50.4% timing) versus once-daily (83.1% regimen, 74.2% timing) dosing.
- Meta-regression revealed significantly worse adjusted adherence for twice-daily dosing: 14.2% lower regimen adherence and 22.9% lower timing adherence (p≤0.002).
Conclusions:
- Once-daily dosing of chronic cardiovascular medications is associated with superior patient adherence compared to twice-daily dosing.
- Dosing frequency is a critical factor for healthcare providers to consider when prescribing CVD medications to optimize patient compliance.
Background:
Most cardiovascular diseases require patients to take one or more chronic medications, often administered multiple times daily. We sought to determine the impact of once- vs. twice-daily dosing of chronic cardiovascular disease medication on adherence.
Methods:
We searched Medline and Embase from 1/1/86 to 10/15/15 for prospective studies electronically measuring adherence for at least four weeks to oral, chronic cardiovascular disease medications taken one to two times daily. Regimen adherence (the proportion of days with the appropriate number of doses taken) and timing adherence (the number of doses taken within an assigned interval divided by the total number of intervals) were outcomes of interest. Meta-regression was performed to assess how dosing frequency, adjusted for study-level covariates, impacted regimen and timing adherence.
Results:
We identified 26 studies that met inclusion criteria. Forty study arms consisting of 1834 patients (range: 12-501) evaluated once-daily dosing and 18 arms consisting of 451 patients (range: 9-82) evaluated twice-daily dosing. Based upon evaluation of the regimen and timing definitions, unadjusted adherence rates were lower for twice-daily (73.8% and 50.4%) than once-daily dosing (83.1% and 74.2%) of chronic cardiovascular disease medications (p≤0.02 for both). Upon meta-regression, adjusted mean percent regimen and timing adherence for twice-daily dosing was 14.2% (95% confidence interval [CI] 6.8-21.7%) and 22.9% (95%CI 13.0-32.8%) worse than once-daily dosing (p≤0.002 for both).
Conclusion:
Patients appear to be more adherent to cardiovascular disease medications dosed once-daily compared to twice-daily. Dosing frequency may be a factor for providers to consider when selecting an agent to prescribe.
Related Concept Videos
01:01Dosage Regimen: Fixed Dose
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
01:21Dose Size and Dosing Frequency: Determination Methods
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
01:15Drug Dosage Regimen: Overview
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
01:25Dosage Regimen: Multiple Oral Dosage