Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories

Abstract

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 antihypertensive 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 II receptor blockers (n=2088), calcium channel blockers (n=937), angiotensin converting enzyme inhibitors (n=665), beta 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 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.

Fig 1 Sample chronology reports for four patients. Arrows indicate days on which medication was not taken

Fig 2 Time course of adherence/compliance parameters (execution, persistence)

Fig 3 Frequency for delaying a dose by more than 30, 42, 54, 66, and 78 hours within and between patients

Fig 4 Proportion of days without drug intake by day of week for each category of takers: morning, evening, or variable

Fig 5 Kaplan-Meier persistence curves stratified by proportion of prescribed drug taken