Elsevier

Clinical Therapeutics

Volume 24, Issue 2, February 2002, Pages 302-316
Clinical Therapeutics

Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: Evidence from a meta-analysis

https://doi.org/10.1016/S0149-2918(02)85026-3Get rights and content

Abstract

Background: Rates of patient adherence (compliance) to pharmacotherapy range from <5% to >90%. Negative determinants include multiple daily dosing (MDD), chronic duration, and asymptomatic disease. Reports suggest that once-daily (QD) dosing may improve adherence, but their findings are inconclusive.

Objective: The purpose of this study was to compare the rates of adherence with QD, twice-daily (BID), and MDD antihypertensive drug regimens.

Methods: MEDLINE, Embase, and International Pharmaceutical Abstracts databases were searched to identify comparative trials of patient adherence to antihypertensive medication in solid, oral formulations. Data were combined using a random-effects meta-analytic model.

Results: Eight studies involving a total of 11,485 observations were included (1830 for QD dosing, 4405 for BID dosing, 4147 for dosing >2 times daily [>BID], and 9655 for MDD), in which the primary objective was to assess adherence. The average adherence rate for QD dosing (91.4%, SD = 2.2%) was significantly higher (Z = 4.46, P < 0.001) than for MDD (83.2%, SD = 3.5%). This rate was also significantly higher (Z = 2.22, P = 0.026) than for BID dosing (92.7% [SD = 2.3%] vs 87.1% [SD = 2.9%]). The difference in adherence rates between BID dosing (90.8%, SD = 4.7%) and >BID dosing (86.3%, SD = 6.7%) was not significant (Z = 1.82, P = 0.069).

Conclusions: The results of this meta-analysis demonstrate that with antihypertensive medications, QD dosing regimens are associated with higher rates of adherence than either BID or MDD regimens.

References (32)

  • B Blackwell

    The drug regimen and treatment compliance

  • RB Haynes

    Determinants of compliance: The disease of the mechanics of treatment

  • J Reid

    Medication compliance in the elderly: A review

    J Clin Exp Gerontol

    (1985)
  • JS Berg et al.

    Medication compliance: A healthcare problem

    Ann Pharmacother

    (1993)
  • VO Leirer et al.

    Elders' nonadherence: Its assessment and medication reminding by voice mail

    Gerontologist

    (1991)
  • W Cochran

    The combination of estimates from different experiments

    Biometrics

    (1954)
  • Cited by (234)

    • US trends in premature heart disease mortality over the past 50 years: Where do we go from here?

      2020, Trends in Cardiovascular Medicine
      Citation Excerpt :

      Issuing prescriptions of longer duration, i.e. 90 vs. 30 days, using fixed-dose combination pills where two or more medications are combined into one pill, and synchronizing medication regimens, where all prescriptions are received during a single pharmacy visit, make it more convenient for patients to adhere to medication regimens, particularly if they are complicated [123,124]. Moreover, lower dosing frequency can improve adherence [125–127]. To ensure that needed medications are taken as directed, the care team can suggest ways for patients to be reminded to take their medications, such as through use of pill boxes or mobile-health interventions like daily calendar reminders in phones, text messages, or reminder apps [128].

    View all citing articles on Scopus
    1

    At the time this research was performed, Michael Iskedjian was a student of the Graduate Department of Pharmaceutical Sciences at the University of Toronto.

    View full text