Costa Francesco Vittorio
Madre Fortunata Toniolo Hospital, Via Toscana, 31, 40141, Bologna, Italy.
High Blood Press Cardiovasc Prev. 2017 Sep;24(3):265-274. doi: 10.1007/s40292-017-0221-4. Epub 2017 Jul 10.
Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.
对抗高血压治疗的依从性差是血压（BP）控制不理想的最重要单一因素。本综述聚焦于影响依从性的治疗相关因素，并提出如何通过明智选择治疗方案来改善依从性。复杂的药物治疗方案、耐受性差和药物替换是依从性差的常见原因，而这反过来又会导致血压控制不足、心血管事件发生率增加，最终导致全球医疗成本升高。还讨论了开具仿制药和药物替换对依从性的影响。就依从性而言，除非患者必须承担非常高的“自付费用”来购买原研药，否则仿制药似乎并不比品牌药更好，这表明仅以降低治疗成本为目的换药并无优势。固定剂量复方制剂的可用性在提高依从性（进而减少心血管事件和医疗支出）方面也发挥着重要作用；在抗高血压药物中，血管紧张素受体阻滞剂（ARB）与较高的依从性和持续性相关。在ARB中，奥美沙坦因有多种有效的固定剂量复方制剂可供选择而脱颖而出。
