title: Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients.
abstract: 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.
authors: Daiichi Sankyo Inc., Parsippany, NJ, USA.
authors: Sumeet
authors: S
authors: Panjabi
authors: Michael
authors: M
authors: Lacey
authors: Timothy
authors: T
authors: Bancroft
authors: Felix
authors: F
authors: Cao
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics