Archief Roodbont

Antihypertensive treatment adherence varies with drug class

13 April 2011

MedWire News: Meta-analysis findings show that patient adherence to antihypertensive medications differs with drug class.

“There was a remarkable degree of consistency in the pattern of our results showing superior adherence to angiotensin II receptor blockers (ARBs) and ACE inhibitors, and inferior adherence to diuretics and beta blockers,” comment the authors.

They highlight, however, that drug adherence was suboptimal for all drug classes, and therefore advocate that “it is important for clinicians to pay attention to adherence regardless of antihypertensive drug class.”

The 17-study meta-analysis involved 935,920 patients with a mean age of 61.7 years, who were prescribed ARBs, ACE inhibitors, beta blockers, calcium channel blockers (CCBs), and/or diuretics to treat pre-existing hypertension.

Writing in the journal Circulation, Ian Kronish (Mount Sinai School of Medicine, New York, USA) and team report that the mean adherence to prescribed antihypertensives varied from 28% for beta blockers to 65% for ARBs.

Patient adherence was greatest for ARBs, with rates 33% and 57% higher for this class than for ACE inhibitors and CCBs, respectively.

Adherence to ARBs was around twice that for diuretics and beta blockers, and, “overall, ACE inhibitors appeared to have the second-best level of adherence, followed by CCBs,” the authors note.

They add, however, that “insufficient data were available for definitive rankings.”

In a related commentary, Niteesh Choudhry (Brigham and Women’s Hospital, Boston, Massachusetts, USA) hypothesized that unexpected side effects, complicated dosing regimens, and poor clinician follow-up may underlie the poor rates of adherence observed in the current study.

He encouraged clinicians to take measures to overcome these obstacles, such as routinely asking patients about therapeutic adherence and substituting complex dosing schedules for simpler ones where possible.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer
Circulation 2011; 123: 1584–1586, 1611–1621