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[One year adherence of ramipril versus ramipril/amlodipine fixed dose combination therapy in hypertension]
Gábor Simonyi1, Tamás Ferenci2
1Anyagcsere Központ, Szent Imre Egyetemi Oktatókórház Budapest, Tétényi út 12-16., 1115.
Insights
Fixed-dose combination therapy with ramipril/amlodipine shows significantly better one-year adherence in hypertensive patients compared to ramipril monotherapy. This improved persistence suggests fixed-dose combinations are preferable for achieving blood pressure targets.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Achieving target blood pressure is crucial for preventing cardiovascular complications in hypertension management.
- Patient adherence to medication regimens is vital for effective treatment outcomes.
- Fixed-dose combination therapies may improve adherence by simplifying treatment plans.
Purpose of the Study:
- To evaluate the one-year adherence rates of ramipril monotherapy versus ramipril/amlodipine fixed-dose combination therapy in patients with hypertension.
Main Methods:
- Analysis of a Hungarian pharmacy claims database (October 2012 - September 2013).
- Inclusion of newly prescribed ramipril or ramipril/amlodipine therapies for hypertension.
- Application of discrete-time survival analysis to model medication discontinuation.
Main Results:
- A total of 92,546 patients were included in the study.
- One-year persistence rates were 30% for ramipril and 54% for ramipril/amlodipine.
- The hazard of discontinuation was more than twofold higher for ramipril monotherapy compared to the fixed-dose combination (HR = 2.11).
Conclusions:
- Ramipril/amlodipine fixed-dose combination therapy demonstrates significantly better one-year persistence than ramipril monotherapy in hypertensive patients.
- Improved adherence with fixed-dose combinations supports their preference for achieving blood pressure goals.
- Fixed-dose combination therapy is a valuable strategy for enhancing treatment adherence and efficacy in hypertension management.
Introduction:
In the treatment of hypertension avoiding adverse cardiovascular complications to achieve target blood pressure is essential. The appropriate drug selection, and if necessary to change to combination therapy, patients adherence is important which may help fixed dose combination.
Aim:
The aim of the authors was to investigate the one year adherence of the ramipril and ramipril/amlodipine fixed dose combination in hypertensive patients.
Method:
Prescriptions database of the National Health Insurance Fund in Hungary on pharmacy-claims was analysed between October 1, 2012 and September 30, 2013. The authors identified patients who filled prescriptions for ramipril monotherapy and fixed dose combinations of ramipril/amlodipine prescribed for the first time in hypertensive patients who have not received similar drugs in the previous year. To model the adherence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable.
Results:
92,546 patients met the inclusion criteria. During the trial period, ramipril therapy or ramipril/amlodipine fixed dose combination was started in 82,251 and 10,295 patients, respectively. One year persistence rate in patients with ramipril was 30% and 54% in patients with ramipril/amlodipine fixed dose combination therapy. Considering only the 360-day study period, the mean duration of persistence was 189.9 days in patients on ramipril and 270.6 days on ramipril/amlodipine fixed dose combination therapy. The hazard of discontinuation was more than twofold higher during treatment with ramipril compared with the use of the ramipril/amlodipine fixed dose combination therapy (HR = 2.11 [95% CI: 2.05-2.17], p<0,001).
Conclusions:
There is a significant difference between the one year persistence of ramipril and ramipril/amlodipine fixed dose combination therapy in hypertension. The result demonstrated that ramipril/amlodipine fixed dose combination therapy has a better one year persistence rate. When the next step is necessary to achieve target blood pressure, ramipril/amlodipine fixed dose combination therapy is preferable. Orv Hetil. 2017; 158(42): 1668-1673.
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