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Effect of Combination Therapy on Adherence Among US Patients Initiating Therapy for Hypertension: a Cohort Study
Julie C Lauffenburger1, Joan E Landon2, Michael A Fischer2
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA. jlauffenburger@bwh.harvard.edu.
Insights
Starting fixed-dose combination pills for hypertension improves medication adherence and persistence compared to single therapies. This finding supports using combination pills for better long-term patient outcomes in managing high blood pressure.
Area of Science:
- Cardiovascular medicine
- Pharmacology
- Health services research
Background:
- Growing evidence suggests patients need more aggressive treatment for hypertension.
- The optimal initial anti-hypertensive strategy for long-term adherence is unclear.
Purpose of the Study:
- To analyze current anti-hypertensive medication initiation patterns.
- To compare adherence and persistence between fixed-dose combinations and single anti-hypertensive therapies.
Main Methods:
- Retrospective cohort study using nationwide insurance claims (2009-2013).
- Categorized patients into fixed-dose combination, multi-pill combination, or single therapy groups.
- Assessed 12-month persistence, adherence (≥80% days covered), and refill rates using regression models.
Main Results:
- Over 484,000 patients initiated treatment; 78,958 used fixed-dose combinations.
- Fixed-dose combination initiators showed 9% greater persistence and 13% greater adherence.
- Refill rates were also higher for fixed-dose combination users.
Conclusions:
- Fixed-dose combination pills improve adherence and persistence in newly treated hypertensive patients.
- This strategy may be beneficial for long-term management of hypertension.
Background:
New trial evidence suggests that many patients may require more aggressive pharmacologic management to achieve lower blood pressure goals. Especially when first initiating anti-hypertensive treatment, it is unknown whether starting patients on multiple medications may be better for long-term adherence and persistence compared with starting one medication.
Objective:
To examine contemporary patterns of anti-hypertensive therapy initiation and compare long-term adherence and persistence among patients initiating fixed-dose combinations and single anti-hypertensive therapies.
Design:
Retrospective cohort study.
Patients:
Using claims from a large nationwide insurer, we identified all patients initiating oral hypertension treatment from 2009 to 2013. We categorized patients into three categories based on the number and type of anti-hypertensive medications they initiated: a fixed-dose combination, a multi-pill combination or a single therapy.
Main Measures:
The primary outcome was persistence to any anti-hypertensive medication, either the initiated medication or other anti-hypertensive, 12 months after initiation in administrative claims. We also measured adherence to at least one anti-hypertensive in the 12 months after initiation and refilling at least one anti-hypertensive medication as outcomes. Full adherence was defined as having ≥80% of potential days covered with medication. Multivariable modified Poisson regression models were used to examine the association between initiating a fixed-dose combination anti-hypertensive and medication outcomes.
Key Results:
Of the 484,493 patients who initiated oral anti-hypertensives, 78,958 patients initiated fixed-dose combinations, 383,269 initiated a single therapy, and 22,266 initiated multi-pill combinations. Patients initiating fixed-dose combinations were 9% more likely to be persistent (relative risk [RR]: 1.09, 95% CI: 1.08-1.10) and 13% more likely to be adherent (RR: 1.13 95% CI: 1.11-1.14) than those who started on a single anti-hypertensive therapy. Refill rates were also slightly higher among fixed-dose combination initiators.
Conclusions:
Fixed-dose combination pills appear to enhance adherence and persistence to anti-hypertensive medications among commercially insured patients starting treatment compared with single therapy.
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