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Effect of Combination Therapy on Adherence Among US Patients Initiating Therapy for Hypertension: a Cohort Study

2017; Springer Science+Business Media; Volume: 32; Issue: 6 Linguagem: Inglês

10.1007/s11606-016-3972-z

1525-1497

Julie C. Lauffenburger, Joan Landon, Michael A. Fischer,

Pharmaceutical Practices and Patient Outcomes

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. 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. Retrospective cohort study. 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. 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. 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. Fixed-dose combination pills appear to enhance adherence and persistence to anti-hypertensive medications among commercially insured patients starting treatment compared with single therapy.