Article
Drug regimen compliance in uncontrolled hypertension
Medikamenten-Compliance bei unkontrollierter Hypertonie
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Published: | November 11, 2004 |
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Outline
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Objectives
To compare drug regimen compliance (DRC) in hypertensives treated with combination therapy whose blood pressures (BP) are controlled vs uncontrolled after 4 weeks of self-monitored BP measurement. To observe the consequences in uncontrolled patients of switching one drug of the combination therapy to candesartan/HCTZ with and without a compliance intervention program.
Methods
Self- and ambulatory-monitoring of BP were done with validated upper arm oscillometric devices. Patients' dosing histories were compiled electronically (MEMS(c), AARDEX).
Results
Patients with BP >140/90 mmHg despite combination therapy were begun on MEMS monitoring and self BP measurement for 4 weeks of run-in. Of 62 such patients, 18 of 61 (29.5%) evaluable patients were normotensive at 4 weeks (Group A); in the remaining 43 still uncontrolled patients, candesartan/HCTZ was substituted for one of the combination therapy drugs, with half these patients receiving passive compliance monitoring (B) and half a DRC intervention program (C). All groups were then followed for 8 weeks. DRC before week 4 was significantly higher in A than in the uncontrolled patients (B&C). DRC was stable during run-in in A, but declined in B and C. After the change to candesartan/HCTZ in B&C, systolic BP was significantly reduced (p<0.04 in B, p<0.01 in C, week 12 vs 4). DRC after week 4 was not different in the three groups and stayed constant over time. DRC during weekends was lower than during weekdays in all groups.
Conclusions
Normalization of BP was associated with superior drug regimen compliance in previously uncontrolled patients treated with a combination drug regimen. Switching still-uncontrolled patients to candesartan/HCTZ significantly reduced systolic BP and stabilized a declining DRC. Further study is needed to determine the time-period in the patient's antecedent drug dosing history when DRC has its greatest influence on present BP, and the role of poor DRC on weekends.