Document Detail

Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients.
MedLine Citation:
PMID:  23321404     Owner:  NLM     Status:  MEDLINE    
Poor antihypertensive treatment adherence adversely affects blood pressure control. We analyzed US health plan data to assess the impact of fixed- versus loose-dose triple-combination therapy on adherence, clinical, and economic outcomes. Patients initiating triple therapy with an angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, or beta blocker plus amlodipine and hydrochlorothiazide comprised three cohorts. Within-cohort comparisons were made between fixed-dose combinations of two antihypertensives plus a second pill (two pills) or three separate pills. Outcomes included adherence, cardiovascular events, health care resource use, and costs for patients with ≥ 12 months follow-up. A total of 16,290 patients were matched. Patients receiving two pills were more likely to be adherent (P < .001) and less likely to discontinue treatment (P < .001) across all cohorts. Therapy with two versus three pills resulted in significantly lower adjusted risk of cardiovascular events (hazard ratio = 0.76, P = .005) in the beta blocker cohort only. Total adjusted health care costs were significantly lower for two- versus three-pill therapy in the beta blocker cohort only (cost ratio = 0.74 overall, P < .01; 0.71 hypertension-attributable, P < .01). In patients with hypertension requiring triple therapy, fixed-dose combinations that lower pill burden may improve adherence (seen across all cohorts) and clinical outcomes (seen in the beta blocker cohort) without increasing health care costs.
Sumeet Panjabi; Michael Lacey; Timothy Bancroft; Felix Cao
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Society of Hypertension : JASH     Volume:  7     ISSN:  1878-7436     ISO Abbreviation:  J Am Soc Hypertens     Publication Date:    2013 Jan-Feb
Date Detail:
Created Date:  2013-01-16     Completed Date:  2013-07-09     Revised Date:  2013-09-23    
Medline Journal Info:
Nlm Unique ID:  101312518     Medline TA:  J Am Soc Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  46-60     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
Daiichi Sankyo Inc., Parsippany, NJ, USA.
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MeSH Terms
Adrenergic beta-Antagonists / economics,  therapeutic use
Angiotensin II Type 1 Receptor Blockers / economics,  therapeutic use
Angiotensin Receptor Antagonists / economics,  therapeutic use
Antihypertensive Agents / economics*,  therapeutic use*
Calcium Channel Blockers / economics,  therapeutic use
Cost-Benefit Analysis
Diuretics / economics,  therapeutic use
Drug Therapy, Combination / economics
Hypertension / drug therapy*,  economics*,  epidemiology
Medication Adherence / statistics & numerical data*
Middle Aged
Retrospective Studies
Treatment Outcome
United States / epidemiology
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin Receptor Antagonists; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Diuretics

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