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Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study
BACKGROUND: The majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence,...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995349/ https://www.ncbi.nlm.nih.gov/pubmed/29889841 http://dx.doi.org/10.1371/journal.pmed.1002584 |
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author | Verma, Amol A. Khuu, Wayne Tadrous, Mina Gomes, Tara Mamdani, Muhammad M. |
author_facet | Verma, Amol A. Khuu, Wayne Tadrous, Mina Gomes, Tara Mamdani, Muhammad M. |
author_sort | Verma, Amol A. |
collection | PubMed |
description | BACKGROUND: The majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases. METHODS AND FINDINGS: We conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days’ supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86–1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19–98) than in the multipill group (42%, IQR 11–91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81–0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding. CONCLUSIONS: Among older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence. |
format | Online Article Text |
id | pubmed-5995349 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-59953492018-06-21 Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study Verma, Amol A. Khuu, Wayne Tadrous, Mina Gomes, Tara Mamdani, Muhammad M. PLoS Med Research Article BACKGROUND: The majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases. METHODS AND FINDINGS: We conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days’ supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86–1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19–98) than in the multipill group (42%, IQR 11–91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81–0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding. CONCLUSIONS: Among older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence. Public Library of Science 2018-06-11 /pmc/articles/PMC5995349/ /pubmed/29889841 http://dx.doi.org/10.1371/journal.pmed.1002584 Text en © 2018 Verma et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Verma, Amol A. Khuu, Wayne Tadrous, Mina Gomes, Tara Mamdani, Muhammad M. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title | Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title_full | Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title_fullStr | Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title_full_unstemmed | Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title_short | Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study |
title_sort | fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: a population-based retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995349/ https://www.ncbi.nlm.nih.gov/pubmed/29889841 http://dx.doi.org/10.1371/journal.pmed.1002584 |
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