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Adherence to antihypertensive medication investigated
16 May 2008
MedWire News: About half of patients given antihypertensive medication stop their treatment within the first year, researchers highlight.
"The principal modes of non-adherence are quitting treatment early, and, before treatment ends, suboptimal execution of the once a day dosing regimen, with intervals between doses of three or more days," the authors write in this issue of the British Medical Journal, which is focused on hypertension.
Effective antihypertensive drugs are now available, but poor adherence to treatment is common, putting patients at increased risk for cardiovascular events.
To study adherence patterns, Bernard Vrijens (Pharmionic Research Center, Visé, Belgium) and colleagues analyzed data from 4783 patients taking part in phase IV clinical studies who were prescribed a once a day antihypertensive medication.
The drugs prescribed included angiotensin II receptor blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, beta blockers, and diuretics.
On any day of treatment, patients omitted about 10% of their scheduled doses. Forty-two per cent of these omissions were of a single day's dose and 43% were part of a sequence of several days.
Almost 95% of the patients missed a single dose at least once a year; half of the patients missed a single day's dose at a rate of once a month; 48% of the patients took a drug holiday (>78 hours) at least once a year; and 13% had bi-monthly (six a year) drug holidays.
Patients who took their daily medication as prescribed were less likely to discontinue treatment early than those with poor daily execution of the dosing regimen (hazard ratio=0.84 for 10% increase in dosing execution).
Vrijens and co-workers conclude: "This retrospective analysis of dosing histories of patients prescribed once a day antihypertensive drugs showed that non-persistence is the leading problem with adherence."
They suggest: "Patients who omit sequential doses are at highest risk of quitting early and should be targeted and proactively re-motivated to continue treatment."
