Does a Combination Pill of Antihypertensive Drugs Improve Medication Adherence in Japanese? A Randomized Controlled Trial

• Published in: Circulation Journal Vol. 76; no. 6; pp. 1415 - 1422
• Main Authors: Matsumura, Kiyoshi, Arima, Hisatomi, Tominaga, Mitsuhiro, Ohtsubo, Toshio, Sasaguri, Toshiyuki, Fujii, Koji, Fukuhara, Masayo, Uezono, Keiko, Morinaga, Yuki, Ohta, Yuko, Otonari, Takatoshi, Kawasaki, Junya, Kato, Isao, Tsuchihashi, Takuya, Investigators, for the COMFORT
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2012
• Subjects: Adherence; Administration, Oral; Aged; Analysis of Variance; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Asian Continental Ancestry Group - psychology; Blood Pressure - drug effects; Chi-Square Distribution; Combination pill; Diuretics - administration & dosage; Diuretics - therapeutic use; Drug Combinations; Female; Health Knowledge, Attitudes, Practice - ethnology; Humans; Hydrochlorothiazide - administration & dosage; Hydrochlorothiazide - therapeutic use; Hypertension; Hypertension - drug therapy; Hypertension - ethnology; Hypertension - physiopathology; Japan - epidemiology; Linear Models; Losartan - administration & dosage; Losartan - therapeutic use; Male; Medication Adherence - ethnology; Middle Aged; Randomized controlled trial; Tablets; Time Factors; Treatment Outcome; Japan
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-11-1481

Background: In order to achieve target blood pressure levels to prevent cardiovascular disease, combination therapy of antihypertensive drugs is often required, although it is thought that requiring a patient to take many different pills would reduce adherence to the medication regimen. Whether antihypertensive treatment with a single pill combining antihypertensive drugs would improve medication adherence and blood pressure control was investigated. Methods and Results: A total of 207 hypertensive subjects were randomly assigned to a combination pill group (losartan 50mg/hydrochlorothiazide 12.5mg; n=103) or a control group (an angiotensin receptor blocker and a thiazide diuretic; n=104). Medication adherence was evaluated by pill counts at 1, 3, and 6 months after randomization. The mean adherence rates over 6 months were not different between the 2 groups: 98% in the combination pill group and 98% in the control group. Moreover, the 2 groups included similar numbers of subjects with relatively poor adherence rates (<90%) in each treatment period. The mean blood pressures over the 6-month treatment period were not different between the groups: 131/75mmHg in the combination pill group and 130/75mmHg in the control group (P=0.84/0.96). Conclusions: There were no appreciable effects of the combination pill of antihypertensive drugs on medication adherence or blood pressure control in Japanese patients over a 6-month period. (Circ J 2012; 76: 1415-1422)