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Abstract

Purpose: To conduct a head to head comparison of persistency and compliance associated with representative agents used in the pharmacologic management of hypertension including lisinopril (Zestril), valsartan (Diovan), amlodipine (Norvasc) in a usual care setting.

Methods: This retrospective database study utilized patients continuously benefit-eligible from the Merck-Medco pharmacy claims database from 8/1997 through 7/2000 (N=14.6M). Patients who received an initial (no prescription filled within class during prior 12 months) prescription for lisinopril, valsartan, or amlodipine between 8/1998 through 7/1999 (N=142,945) were included and followed for 12 months. Compliance was assessed using the medication possession ratio (MPR), or the percentage of time a patient had drug available over a 1-year time period. Persistency was defined as having drug on hand at least one day in the month. To control for differences in overall baseline chronic disease burden, a Chronic Disease Score (CDS), which uses drug markers to identify chronic conditions, was used to classify the cohort as mild, moderate, or severe.

Results: Mean age of the study cohort was 63.1 years and 53% were female. Over half (51%) of the cohort used amlodipine as initial therapy, 21% valsartan, and 28% lisinopril. More valsartan patients remained persistent on therapy at 12-months post-therapy initiation (66%) compared to amlodipine (57%) and lisinopril (55%) (p<.0001, both comparisons). Mean duration of therapy was 266 days for valsartan patients versus 246 days for amlodipine and 240 days for lisinopril (p<.0001, both comparisons). Compliance was also greatest for valsartan patients, reflecting a mean MPR of 76% vs. 67% for amlodipine, 65% for lisinopril (p<.0001, both comparisons). While a slightly greater proportion of valsartan patients had a lower CDS (31% classified as severe, vs. 35% for both lisinopril and amlodipine), compliance and duration of therapy remained greater for valsartan patients across all CDS strata. Valsartan patients classified as severe via CDS had a mean duration of therapy of 266 days, compared to 245 for amlodipine and 237 for lisinopril (p<.0001, both comparisons). These patients also had a mean MPR of 75% as compared to 67% and 64% for amlodipine and lisinopril patients, respectively (p<.0001, both comparisons).

Conclusion: These preliminary results suggest that patients receiving valsartan in a typical managed care setting for the treatment of hypertension may be more adherent to therapy. These differences appear to be independent of baseline CDS.

Research funded by Novartis Pharmaceuticals

Hypertension, Compliance, Chronic Disease Score
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© American Journal of Hypertension, Ltd. 2001
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