Department of Integrative Pharmacology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Department of Pharmacy, Osaka University Hospital, Suita, Osaka, Japan.
PLoS One. 2021 Jun 10;16(6):e0252944. doi: 10.1371/journal.pone.0252944. eCollection 2021.
Good adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension.
According to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score.
Among 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar.
Our study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.
为了实现高血压治疗，建议患者坚持服用降压药。已知药物数量和影响药物治疗方案复杂性的药物特征（如剂型和给药频率）会影响药物依从性，但药物治疗方案的复杂性对药物疗效的影响仍有待阐明。在本研究中，我们回顾性调查了药物数量和药物治疗方案复杂性对高血压患者药物依从性和治疗效果的影响。
根据纳入和排除标准，共纳入 2018 年 7 月至 2018 年 12 月在日本三重大学医院入院时正在服用包括降压药在内的药物的 1057 例患者。如果收缩压或舒张压≥140mmHg 或≥90mmHg，则定义为血压控制不佳。使用药物治疗方案复杂性指数（MRCI）评分量化药物治疗方案的复杂性。
在 1057 例患者中，164 例和 893 例患者分别归入药物依从性差和药物依从性好的组。多变量分析显示，年龄≥71 岁和口服 MRCI 评分≥19.5 但不是口服药物数量是药物依从性差的危险因素。无论年龄大小，口服 MRCI 评分≥19.5 的患者药物依从性和血压控制都较差。再入院率相似。
我们的研究首次表明，药物治疗方案的复杂性而不是药物数量与药物依从性和血压控制密切相关。因此，医生和/或药剂师在调整药物治疗方案时应考虑药物治疗方案的复杂性。
