title: Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority?
abstract: Data on the long-term outcomes of the use of fixed-dose combinations (FDCs) or free-pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008-2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score-adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first-line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL.
authors.forename: Kalyani B
authors.initials: KB
authors.lastname: Sonawane Deshmukh
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Qian
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Garza
authors.affiliation: Pharmacy Practice, Auburn University, Auburn, AL.|The University of Alabama at Birmingham, Huntsville, AL.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Wright
authors.affiliation: Mathematics and Statistics, Auburn University, Auburn, AL.
authors.forename: Peng
authors.initials: P
authors.lastname: Zeng
authors.affiliation: Management Policy and Community Health, The University of Texas Health Science Centre at Houston, Houston, TX.
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Ganduglia Cazaban
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL. rah0019@auburn.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations