title: [Ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combinations and patient's adherence].
abstract: BACKGROUND
  Patient's adherence has a great significance to reach target blood pressure values. The risk of cardiovascular adverse events decreases when patients are on target blood pressure.
  
  
  OBJECTIVE
  The aim of the authors was to investigate the one-year persistence of the ramipril/amlodipine and lisinopril/amlodipine fixed dose combination in hypertensive patients.
  
  
  METHODS
  National Health Insurance Found prescriptions database of Hungary on pharmacy-claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for fixed dose combinations of ramipril and amlodipine, and lisinopril and amlodipine prescribed for the first time, for the therapeutic indication of hypertension. Patients have not received antihypertensive therapy with similar active substances during one year before the study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable.
  
  
  RESULTS
  During the study period, fixed dose combination antihypertensive therapy with ramipril plus amlodipine and lisinopril plus amlodipine was started in 10,449 and 20,276 patients, respectively. One-year persistence rate in patients taking ramipril and amlodipine as a fixed dose combination was 54%, whereas 36% in those on the fixed lisinopril and amlodipine combination. Considering only the 360-day study period, the mean duration of persistence was 271 days in patients on the ramipril based and 211 days on lisinopril based fixed dose combination. Analyzing persistence on treatment with these combinations showed that the actual rate of discontinuation was about twice higher during treatment with the lisinopril and amlodipine fixed dose combination compared with the use of the ramipril and amlodipine fixed dose combination (hazard ratio = 1.79, p<0.001).
  
  
  CONCLUSIONS
  There is a significant difference between the one-year persistence of ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combination in patients with hypertension. The result demonstrated that ramipril and amlodipine fixed dose combination has a favourable patients' adherence as compared to lisinopril and amlodipine fixed dose combination.
authors.affiliation: Anyagcsere Központ, Szent Imre Egyetemi Oktatókórház Budapest, Tétényi út 12-16., 1115.
authors.forename: Gábor
authors.initials: G
authors.lastname: Simonyi
authors.affiliation: Élettani Szabályozások Csoport, Óbudai Egyetem, Neumann János Informatikai Kar Budapest.
authors.forename: Tamás
authors.initials: T
authors.lastname: Ferenci
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016208:Databases, Factual; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D017706:Lisinopril / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000008:administration & dosage*; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004338:Drug Combinations; D017311:Amlodipine; D017706:Lisinopril; D017257:Ramipril
keywords: antihypertensiv terápia; antihypertensive therapy; lisinopril/amlodipin fix kombináció; lisinopril/amlodipine fixed dose combination; persistence; perzisztencia; ramipril/amlodipin fix kombináció; ramipril/amlodipine fixed dose combination