Patient Adherence and Duration of Continuous Treatment With Various Arbs in Patients With Uncomplicated Arterial Hypertension in the USA Based on The Analysis of the Truven Health Analytics MarketScan Database.

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Yu N Belenkov, M G Glezer, M V Kozhevnikova, K S Chernichka, N V Matveev
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Abstract

Aim: To discuss two aspects that can be used to improve the adherence to therapy in patients with arterial hypertension (AH): 1) which of the angiotensin II receptor blockers (ARBs) provides the highest adherence rates; 2) how various factors influence adherence rates.

Material and methods: An analysis of one of the world's largest clinical practice databases, Truven Health Analytics MarketScan (currently Merative MarketScan), was performed. The analysis included data on patients of both sexes aged 30 to 65 years who had been diagnosed with uncomplicated AH (at least once between March 1, 2012 and January 1, 2018) and prescribed monotherapy with one of ARBs. The exclusion criteria were heart failure and the treatment with two or more ARBs (simultaneously or sequentially) during the treatment period. Ultimately, the study included 717,099 patients with uncomplicated AH, who were divided into four groups based on the prescribed drug: azilsartan (n=4276), candesartan (n=6023), losartan (n=586,857), and valsartan (n=119,943). Adherence to treatment was evaluated by two parameters: duration of continuous therapy and medication possession ratio (MPR). The individual effect of each factor (specific ARB used for therapy, patient gender, age, initial ARB dose, patient co-payment per day of treatment) on the adherence to treatment was assessed using a regression analysis.

Results: The adherence to the ARB therapy was generally high. The MPR was the lowest in the azilsartan group and the highest in the candesartan group. However, the parameters that potentially influenced both the MPR and the duration of continuous therapy (patient's gender and age, initial ARB dose, co-payment size) differed significantly between the groups receiving different ARBs. The regression analysis showed that both adherence parameters and the duration of continuous therapy were higher in patients receiving candesartan than in patients receiving azilsartan, losartan or valsartan, when the effect on the adherence of other factors available for study (age, gender, initial dose of the drug, and the absolute size of co-payment for a day of therapy) was excluded. The lowest adherence to therapy was observed in the azilsartan treatment group (p<0.01).

Conclusion: The study provided data for comparing the adherence of patients with uncomplicated AH to the therapy with different ARBs. Further study of adherence to treatment will provide additional data that will allow an optimal selection of drugs for the treatment of AH in patients with potentially poor adherence.

基于 Truven Health Analytics MarketScan 数据库分析的美国无并发症动脉高血压患者持续使用各种 Arbs 治疗的依从性和持续时间。
目的:讨论可用于改善动脉高血压(AH)患者坚持治疗的两个方面:1)哪种血管紧张素 II 受体阻滞剂(ARB)的坚持治疗率最高;2)各种因素如何影响坚持治疗率:对全球最大的临床实践数据库之一 Truven Health Analytics MarketScan(现为 Merative MarketScan)进行了分析。分析包括年龄在 30 岁至 65 岁之间、被诊断为无并发症的急性心肌梗死(2012 年 3 月 1 日至 2018 年 1 月 1 日期间至少一次)并接受过一种 ARB 单药治疗的男女患者的数据。排除标准为心力衰竭以及在治疗期间(同时或先后)接受过两种或两种以上 ARBs 治疗。最终,研究纳入了717099名无并发症的AH患者,根据处方药物将其分为四组:阿齐沙坦(n=4276)、坎地沙坦(n=6023)、洛沙坦(n=586857)和缬沙坦(n=119943)。治疗依从性通过两个参数进行评估:持续治疗时间和药物持有率(MPR)。使用回归分析评估了各因素(治疗中使用的特定 ARB、患者性别、年龄、初始 ARB 剂量、患者每天治疗的自费部分)对坚持治疗的影响:结果:ARB 治疗的依从性普遍较高。阿齐沙坦组的MPR最低,坎地沙坦组最高。然而,对MPR和持续治疗时间有潜在影响的参数(患者的性别和年龄、初始ARB剂量、自费金额)在接受不同ARB治疗的组别之间存在显著差异。回归分析表明,在排除其他可研究因素(年龄、性别、药物初始剂量和一天治疗的自费金额绝对值)对治疗依从性的影响后,接受坎地沙坦治疗的患者的治疗依从性参数和持续治疗时间均高于接受阿齐沙坦、洛沙坦或缬沙坦治疗的患者。阿齐沙坦治疗组的治疗依从性最低(p<0.01):该研究为比较无并发症 AH 患者对不同 ARB 治疗的依从性提供了数据。对治疗依从性的进一步研究将提供更多数据,从而为依从性可能较差的急性心肌梗死患者选择最佳药物进行治疗。
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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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