ArticleBMC family practice2008
Improved persistence and adherence to diuretic fixed-dose combination therapy compared to diuretic monotherapy.
Article in BMC family practice, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 31 citations in OpenAlex.
- A titrate-to-goal study of switching patients uncontrolled on antihypertensive monotherapy to fixed-dose combinations of amlodipine and olmesartan medoxomil ± hydrochlorothiazide.Journal of clinical hypertension (Greenwich, Conn.) · 2011Trial
- Factors associated with medication adherence among young adults with hypertension.Clinical hypertension · 2025Article
- Effects of combination drugs on antihypertensive medication adherence in a real-world setting: a Korean Nationwide Study.BMJ open · 2019Article
- The association of angiotensin receptor blocker-based combination therapy with persistence and adherence in newly treated, uncomplicated hypertensive patients.Patient preference and adherence · 2019Article
- How does prescribing for antihypertensive products stack up against guideline recommendations? An Australian population-based study (2006-2014).British journal of clinical pharmacology · 2016Article
- Persistence to antihypertensive drug classes: A cohort study using the Swedish Primary Care Cardiovascular Database (SPCCD).Medicine · 2016Observational
- Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority?Journal of clinical hypertension (Greenwich, Conn.) · 2016Article
- Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis.BMC health services research · 2013Article
- Diuretics for hypertension-reasons for a contradiction in primary care prescribing behavior: a qualitative study.Journal of clinical hypertension (Greenwich, Conn.) · 2012Article
- Impact of prescription benefit coverage limits on sevelamer hydrochloride adherence for patients with ESRD.American health & drug benefits · 2009Article
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Authors and funding
5 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundDiuretics are recommended as initial treatment for hypertension. Several studies have suggested suboptimal persistence and adherence to thiazide diuretic monotherapy; this study compared patient persistence and adherence with hydrochlorothiazide (HCTZ) monotherapy to fixed-dose combinations containing HCTZ.
methodsPatients with at least one prescription claim during 2001 to 2003 for either HCTZ or one of the following fixed-dose combinations: angiotensin-receptor blockers/HCTZ (ARB/HCTZ), angiotensin-converting enzyme inhibitor/HCTZ (ACEI/HCTZ), or beta blockers/HCTZ (BB/HCTZ) were identified. Patients were required to be continuously benefit-eligible six months pre- and one year post-index date, and to have no prescription claims for any antihypertensive therapy six months prior to the index date. Patients were followed for one year to assess persistence, medication possession ratio (MPR), adherence (MPR >80%), and proportion of days covered (PDC) with initial antihypertensive therapy. Logistic regression was used to calculate adjusted odds ratios for persistence, adherence and PDC, adjusted for age, gender, business segment, RxRisk disease categories, average co-pay and concurrent cardiovascular-related medication utilization.
resultsThe study cohort consisted of 48,212 patients; 72.5% used HCTZ, 13.2% ACEI/HCTZ, 9.3% ARB/HCTZ, and 5.0% BB/HCTZ. Mean age was 53.7 years and 66.5% were female. A significantly lower proportion of patients using HCTZ (29.9%) remained persistent with therapy at 12 months compared with ARB/HCTZ (52.6%; OR = 0.37, CI = 0.36, 0.38), ACEI/HCTZ (51.4%; OR = 0.38, CI = 0.37, 0.39), and BB/HCTZ (51.9%; OR = 0.38, 0.37, 0.40). Similarly, PDC was lower for HCTZ patients (32.5%) as compared to ARB/HCTZ (53.7%; OR = 0.39, CI = 0.37, 0.40), ACEI/HCTZ (50.9%; OR = 0.42, CI = 0.40, 0.43), and BB/HCTZ (51.3%; OR = 0.44, CI 0.42, 0.45). MPR was also significantly lower for HCTZ patients as compared to those using fixed-dose combination therapies.
conclusionInitiating HCTZ fixed-dose combination therapy with an ACEI, ARB, or BB was associated with greater persistence and adherence as compared to HCTZ monotherapy. Further research is needed to determine the relationship between improved persistence and adherence with blood pressure control.
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