Taylor Addison A, Shoheiber Omar
Section of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX 77030, USA.
Congest Heart Fail. 2003 Nov-Dec;9(6):324-32. doi: 10.1111/j.1527-5299.2003.03269.x.
Adhering to medication regimens has the potential to significantly improve clinical outcomes for persons with high blood pressure. A patient-related factor likely to affect adherence to treatment is the convenience of the prescribed drug regimen. The authors hypothesized that medication adherence would be superior and cost benefits would accrue in subjects who receive a once-daily, single-capsule, fixed-dose combination product for blood pressure control, compared with subjects who receive a similar regimen of separate components. A managed care organization that provides benefits for members enrolled in various health plans provided the data for this retrospective analysis. The database was used to assess medication adherence patterns for two groups of hypertensive subjects. Group 1 included subjects who had been prescribed the single-capsule, fixed-dose combination of amlodipine besylate/benazepril HCl. Group 2 comprised subjects who had been prescribed a regimen including an angiotensin-converting enzyme inhibitor and a dihydropyridine calcium channel blocker as separate drugs. Adherence was measured by the medication possession ratio, and medical resource utilization by the two groups was assessed during the study period. Group 1 (n=2754) and Group 2 (n=2978) were balanced with regard to age (mean, 53 years; range, 18-64 years) and sex (men, 50%; women, 50%). The overall medication possession ratio for Group 1 was significantly higher than that for Group 2 (80.8% vs. 73.8%; p<0.001). The average annual cost of cardiovascular-related care per subject was significantly lower in Group 1 compared with Group 2 (p<0.001). Subjects receiving the once-daily, single-capsule, fixed-dose combination of amlodipine/benazepril HCl demonstrated significantly better medication adherence and required fewer medical resources than did subjects receiving an angiotensin-converting enzyme inhibitor and a dihydropyridine calcium channel blocker as separate components.
坚持药物治疗方案有可能显著改善高血压患者的临床结局。一个可能影响治疗依从性的患者相关因素是所开药物治疗方案的便利性。作者推测,与接受类似的分开成分治疗方案的受试者相比,接受每日一次、单胶囊、固定剂量复方产品来控制血压的受试者,其药物依从性会更好,且能产生成本效益。一个为参加各种健康计划的成员提供福利的管理式医疗组织为这项回顾性分析提供了数据。该数据库用于评估两组高血压受试者的药物依从模式。第1组包括被开了苯磺酸氨氯地平/盐酸贝那普利单胶囊、固定剂量复方制剂的受试者。第2组包括被开了一种包含血管紧张素转换酶抑制剂和二氢吡啶类钙通道阻滞剂的分开药物治疗方案的受试者。通过药物持有率来衡量依从性,并在研究期间评估两组的医疗资源利用情况。第1组(n = 2754)和第2组(n = 2978)在年龄(平均53岁;范围18 - 64岁)和性别(男性50%;女性50%)方面保持平衡。第1组的总体药物持有率显著高于第2组(80.8%对73.8%;p<0.001)。与第2组相比,第1组中每位受试者每年心血管相关护理的平均成本显著更低(p<0.001)。与接受血管紧张素转换酶抑制剂和二氢吡啶类钙通道阻滞剂作为分开成分的受试者相比,接受每日一次、单胶囊、固定剂量的氨氯地平/盐酸贝那普利复方制剂的受试者表现出显著更好的药物依从性,且所需医疗资源更少。