Does Synchronizing Initiation of Therapy Affect Adherence to Concomitant Use of Antihypertensive and Lipid-Lowering Therapy?

Although efficacious medications are available to treat hypertension and dyslipidemia, treatment adherence is often poor. This retrospective study evaluated adherence in patients newly initiating antihypertensive (AH) and lipid-lowering (LL) therapies simultaneously versus within 180 days of one another. Data were analyzed for US managed care plan enrollees initiating AH before LL (cohort 1; n = 7099), LL before AH (cohort 2; n = 3229), or AH/LL simultaneously (cohort 3; n = 5072). A multivariate model evaluated potential predictors of adherence (medication possession ratio ≥ 0.80 over a bimonthly period). Percentages of patients adherent to AH/LL at 2, 6, and 12 months were as follows: 59.4%, 32.7%, and 31.3% in cohort 1; 45.0%, 30.8%, and 31.0% in cohort 2; and 75.2%, 34.4%, and 34.0% in cohort 3, respectively. After adjustment for potential confounders, patients initiating AH before LL therapy, or LL before AH therapy, were less likely to be adherent than patients prescribed both agents simultaneously (odds ratios = 0.838 and 0.691, respectively; P < 0.0001). Synchronous initiation of AH and LL therapies is an important predictor of adherence.

[1]  T. Fahey,et al.  How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. , 2004, Archives of internal medicine.

[2]  J. Steiner,et al.  A Systematic Review of the Literature , 2019, HIV/AIDS and Adolescents.

[3]  Alexander G Logan,et al.  The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy , 2009 .

[4]  S. De Geest,et al.  Adherence to Long-Term Therapies: Evidence for Action , 2003, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[5]  M. Robin DiMatteo,et al.  Patient Adherence and Medical Treatment Outcomes: A Meta-Analysis , 2002, Medical care.

[6]  A. Rodgers,et al.  Do fixed-dose combination pills or unit-of-use packaging improve adherence? A systematic review. , 2004, Bulletin of the World Health Organization.

[7]  R. Verbrugge,et al.  Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost , 2005, Medical care.

[8]  M. Weinstein,et al.  Long-term persistence in use of statin therapy in elderly patients. , 2002, JAMA.

[9]  T. Lynch.  Medication costs as a primary cause of nonadherence in the elderly. , 2006, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[10]  L Guize,et al.  Combined effects of systolic blood pressure and serum cholesterol on cardiovascular mortality in young (<55 years) men and women. , 2002, European heart journal.

[11]  D. Singer,et al.  Impact of concurrent medication use on statin adherence and refill persistence. , 2004, Archives of internal medicine.

[12]  S. Grundy,et al.  National Cholesterol Education Program Third Report of the National Cholesterol Education Program ( NCEP ) Expert Panel on Detection , Evaluation , and Treatment of High Blood Cholesterol in Adults ( Adult Treatment Panel III ) Final Report , 2022 .

[13]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[14]  Gerardo Heiss,et al.  Long-term adherence with cardiovascular drug regimens. , 2006, American heart journal.

[15]  P. Ohman,et al.  Patients compliance in hypertension--the importance of number of tablets. , 1984, British journal of clinical pharmacology.

[16]  B. Gersh.  Relationship Between Adherence to Evidence-Based Pharmacotherapy and Long-term Mortality After Acute Myocardial Infarction , 2008 .

[17]  J. Collin,et al.  Persistence with treatment in newly treated middle-aged patients with essential hypertension. , 2005, The Annals of pharmacotherapy.

[18]  R. Collins,et al.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial , 2003, The Lancet.

[19]  D. Battleman,et al.  Predictors of adherence with antihypertensive and lipid-lowering therapy. , 2005, Archives of internal medicine.

[20]  Lawrence A Leiter,et al.  The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. , 2007, The Canadian journal of cardiology.

[21]  P. Thompson,et al.  Magnetic resonance imaging of left atrial thrombus , 2002, Heart.

[22]  S. Bangalore,et al.  Fixed-dose combinations improve medication compliance: a meta-analysis. , 2007, The American journal of medicine.

[23]  Harlan M Krumholz,et al.  Impact of medication therapy discontinuation on mortality after myocardial infarction. , 2006, Archives of internal medicine.

[24]  Shah Ebrahim,et al.  European guidelines on cardiovascular disease prevention in clinical practice: executive summary. , 2007, Atherosclerosis.

[25]  B. Nightengale,et al.  Relationship of Blood Pressure Control to Adherence With Antihypertensive Monotherapy in 13 Managed Care Organizations , 2006, Journal of managed care pharmacy : JMCP.

[26]  J. Gurwitz,et al.  Cost-related medication nonadherence among elderly and disabled medicare beneficiaries: a national survey 1 year before the medicare drug benefit. , 2006, Archives of internal medicine.

[27]  N. Wong,et al.  Prevalence, treatment, and control of combined hypertension and hypercholesterolemia in the United States. , 2006, The American journal of cardiology.

[28]  J. Avorn,et al.  The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. , 1997, American journal of hypertension.

[29]  A. Lagi,et al.  Compliance with therapy in hypertensive patients , 2006, Internal and emergency medicine.

[30]  A. Rabinstein.  Efficacy and safety of cholesterol-lowering treatment: prospective metaanalysis of data from 90 056 participants in 14 randomised trials of statins , 2007 .

[31]  Alexandria,et al.  Recommendations for Evaluating Compliance and Persistence With Hypertension Therapy Using Retrospective Data , 2006, Hypertension.

[32]  Diabetes Uk,et al.  JBS 2: Joint British Societies9 guidelines on prevention of cardiovascular disease in clinical practice , 2005 .

[33]  Neil Chapman,et al.  Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. , 2005, Archives of internal medicine.

[34]  J. Jordan,et al.  Adherence to combined Lamivudine+Zidovudine versus individual components: A community-based retrospective medicaid claims analysis , 2005, AIDS care.

[35]  R. Collins,et al.  Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins , 2005, The Lancet.

[36]  Muhammad Mamdani,et al.  Adherence with statin therapy in elderly patients with and without acute coronary syndromes. , 2002, JAMA.

[37]  A. Vanderplas,et al.  Adherence to oral antidiabetic therapy in a managed care organization: a comparison of monotherapy, combination therapy, and fixed-dose combination therapy. , 2002, Clinical therapeutics.

[38]  A. Lippman.  Adherence to medication. , 2005, The New England journal of medicine.

[39]  Kyle D. Maddox.  British Cardiac Society , 1976, British heart journal.

[40]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.