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The association of angiotensin receptor blocker-based combination therapy with persistence and adherence in newly treated, uncomplicated hypertensive patients

Authors Ah YM, Shin J, Lee JY

Received 21 November 2018

Accepted for publication 10 January 2019

Published 31 January 2019 Volume 2019:13 Pages 241—248


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Johnny Chen

Young-Mi Ah,1 Jaekyu Shin,2 Ju-Yeun Lee3

1College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Republic of Korea; 2Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; 3College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea

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.

Keywords: single pill combination, persistence, adherence, hypertension, angiotensin receptor blocker

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