Achieving Adherence After First‐Line Antihypertensive Treatment: Should Fixed‐Dose Combinations Receive Priority?

Data on the long‐term outcomes of the use of fixed‐dose combinations (FDCs) or free‐pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008‐2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score‐adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first‐line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.     

Copper and Zinc Deficiency in a Patient Receiving Long‐Term Parenteral Nutrition During a Shortage of Parenteral Trace Element Products

Drug shortages in the United States, including parenteral nutrition (PN) components, have been common in recent years and can adversely affect patient care. Here we report a case of copper and zinc deficiency in a patient receiving PN during a shortage of parenteral trace element products. The management of the patient's deficiencies, including the use of an imported parenteral multi–trace element product, is described.