One-year persistence of renin-angiotensin-aldosterone system inhibitors fixed drug combinations in hypertensive patients

Abstract

Various fixed combinations of antihypertensive agents are highlighted in European and Hungarian hypertension guidelines. A renin-angiotensin-aldosterone system antagonist (RAAS inhibitor) in combination with calcium channel blockers (CCBs) or diuretics are recommended as the first step in antihypertensive therapy. The aim of the authors was to compare the one-year persistence of RAAS inhibitor fixed-dose combinations (FDCs) in hypertension. The authors have analyzed the prescription database of the National Health Insurance Fund and selected patients who first filled prescriptions for any RAAS inhibitor FDC between October 1, 2012, and September 30, 2013, and who did not redeem prescriptions for similar preparations in the year preceding the selection period. Apparatus of survival analysis was used, where "survival" was the time to abandon the medication. A total of 443149 patients met the selection criteria. The one-year persistence of angiotensin-converting enzyme inhibitor (ACE inhibitor)/CCB FDCs was 44.59%, while that of angiotensin II receptor inhibitor (ARB)/thiazide diuretic (HCT) FDCs was 42.52%. This was followed by ACE inhibitor/indapamide FDCs at 37.27%, ARB/CCB FDCs at 29.04%, and ACE inhibitors/HCT FDCs at 27.47%. Compared to ACE inhibitor/indapamide FDCs (reference), the risk of discontinuing ACE inhibitor/CCBs was 31 percentage points lower (HR = 0.69, 95% CI 0.6855-0.6996, p<0.0001), and the risk of discontinuing ARB/HCT FDCs was 18 percentage points lower (HR = 0.82, 95% CI 0.8096-0.8267, p<0.0001). However, the risk of discontinuing ACE inhibitor/HCT FDCs was 17 percentage points higher (HR = 1.17, 95% CI 1.1562-1.1825, p<0.0001), and the risk of discontinuing ARB/CCB FDCs was 20 percentage points higher (HR = 1.20, 95% CI 1.17316-1.2239, p<0.0001). The average medication adherence time limited to 360 days was 239.9 days for ACE inhibitor/CCB FDCs, 214.8 days for ARB/HCT FDCs, 193.8 days for ACE inhibitor/indapamide FDCs, 178.8 days for ARB/CCB FDCs, and 177.6 days for ACE inhibitor/HCT FDCs. The authors have demonstrated that the one-year persistence of RAAS inhibitor FDCs varies significantly in hypertensive patients. ACE inhibitor/CCB FDCs were found to be the most advantageous. Orv Hetil. 2023; 164(34): 1337-1341.