Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories
Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories
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DOI：
10.1136/bmj.39553.670231.25
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发表时间：
2008-05-17
影响因子：
105.7
通讯作者：
Burnier, Michel
中科院分区：
文献类型：
--
作者：
Vrijens, Bernard;Vincze, Gabor;Burnier, Michel
目的描述每日一次抗高血压药物治疗患者的用药史特征，设计纵向数据库研究2006年。参与者参与研究的患者，其给药史可通过电子监测获得。主要结果测量处方抗高血压治疗的持续性和每日一次药物给药的执行结果该数据库包含4783例高血压患者的给药史。数据来自21项IV期临床研究，研究时间从30天到330天不等，涉及43种不同的降压药物，包括血管紧张素11受体阻滞剂（n=2088）、钙通道阻滞剂（n=937）、血管紧张素转换酶抑制剂（n=665）、P受体阻滞剂（n=195）和利尿剂（n=155）。大约一半的患者在一年内停止服用抗高血压药物。在任何一天，仍然参与药物给药方案的患者省略了约10%的计划剂量：其中42%是一天的剂量，而43%是连续几天（三天或三天以上，即药物“假期”）的一部分。几乎一半的患者每年至少有一个药物假期。患者将提前停止治疗的可能性是负相关的质量，他或她的日常执行的剂量regiments.Conclusions提前停止治疗和次优的每日坚持执行规定的方案是最常见的方面，每天一次的抗高血压药物治疗的依从性差。这些给药错误造成的药物暴露不足可能是血压控制率低和处方抗高血压药物反应变异性高的常见原因。
Objective To describe characteristics of dosing history in patients prescribed a once a day antihypertensive medication.Design Longitudinal database study.Setting Clinical studies archived in database for 1989-2006.Participants Patients who participated in the studies whose dosing histories were available through electronic monitoring.Main outcome measures Persistence with prescribed anti hypertensive treatment and execution of their once a day drug dosing regimens.Results The database contained dosing histories of 4783 patients with hypertension. The data came from 21 phase IV clinical studies, with lengths ranging from 30 to 330 days and involving 43 different antihypertensive drugs, including angiotensin 11 receptor blockers (n=2088), calcium channel blockers (n=937), angiotensin converting enzyme inhibitors (n=665), P blockers (n=195), and diuretics (n=155). About half of the patients who were prescribed an antihypertensive drug had stopped taking it within one year. On any day, patients who were still engaged with the drug dosing regimen omitted about 10% of the scheduled doses: 42% of these omissions were of a single day's dose, whereas 43% were part of a sequence of several days (three or more days that is, drug "holidays"). Almost half of the patients had at least one drug holiday a year. The likelihood that a patient would discontinue treatment early was inversely related to the quality of his or her daily execution of the dosing regimen.Conclusions Early discontinuation of treatment and suboptimal daily adherence to execution of the prescribed regimens are the most common facets of poor adherence with once a day antihypertensive drug treatments. The shortfalls in drug exposure that these dosing errors create might be a common cause of low rates of blood pressure control and high variability in responses to prescribed antihypertensive drugs.