Key result
Change in ARB pill appearance linked to ~55% lower adherence.
Why the study?
The influence of changes in pill appearance on adherence to angiotensin receptor blockers and blood pressure control was unclear.
Does a change in pill appearance reduce adherence and blood pressure control in patients taking angiotensin receptor blockers?
Cohort (n=602)
Yes
Does a change in pill appearance reduce adherence and blood pressure control in patients taking angiotensin receptor blockers?
Switching between pills of different appearances is associated with lower patient adherence to ARBs and higher rates of uncontrolled blood pressure.
Answers are grounded in this paper and cite their sources.
Changes in pill appearance were associated with lower ARB adherence and higher BP; hypothesis-generating for minimizing formulation switches in hypertension care.
OBJECTIVE: To assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment. DESIGN: Retrospective cohort study of a random sample of consecutive patients collecting their medication. SETTING: 40 community pharmacies in Alicante (Southeast Spain). PARTICIPANTS: 602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included. MAIN OUTCOME MEASURES: Prevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables. RESULTS: 161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136-148) than in those who did not have a change (median BP 127 mm Hg; IQR 118-135; p<0.001). CONCLUSIONS: There was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.
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Lumbreras et al. (2017) conducted a cohort in Hypertension / Angiotensin receptor blocker treatment (n=602). Change in pill appearance vs. No change in pill appearance was evaluated on Adherence to pharmacological treatment (RRa 0.45, 95% CI 0.22 to 0.90, p=0.024). A change in pill appearance was associated with a lower likelihood of adherence to angiotensin receptor blockers compared to no change (adjusted RR 0.45; 95% CI 0.22-0.90; p=0.024).
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