doi: 10.1111/j.1472-8206.2009.00683.x SHORT COMMUNICATION Importance of medication adherence from the ONTARGET and TRANSCEND points of view Vivencio Barrios a *, Carlos Escobar b , Rocio Echarri c a Department of Cardiology, Hospital Ramo ´n y Cajal, Madrid, Spain b Department of Cardiology, Hospital Infanta Sofı ´a, Madrid, Spain c Department of Nephrology, Hospital Infanta Sofı ´a, Madrid, Spain Medication adherence is crucial to improve the prognosis of patients with chronic diseases, such as hypertension [1]. Non-adherence is associated with poorer blood pressure control rates and with higher rates of adverse outcomes [1,2]. There are two major reasons for patients non-adherence. A lack of awareness about the importance of taking their medication everyday and, more importantly, the presence of side effects related to the use of antihypertensive agents [3]. As a result, those antihypertensive agents that are better tolerated, are associated with higher rates of adherence, and consequently, with better blood pressure control and lower cardiovascular outcomes. Importantly, the variables associated with antihyper- tensive medication withdrawal do not usually occur immediately after the cessation, but likely in the following years [1,3]. Nevertheless, since the current randomized clinical trials are limited to a short or mid follow-up, usually no >5 or 6 years, the results provided from these studies do not exactly reflect the importance of the therapy discontinuation. Two recent trials, the ONTARGET [4] and TRAN- SCEND [5] studies, are two clear examples of it. In the ONTARGET trial [4], the authors reported that telmisartan was equivalent to ramipril on the primary endpoint (death from cardiovascular causes, myocardial Keywords adverse outcomes, medication adherence, ONTARGET, TRANSCEND Received 26 November 2008; accepted 15 December 2008 *Correspondence and reprints: vbarriosa@meditex.es; vbarrios.hrc@salud.madrid.org ABSTRACT Medication adherence is crucial to improve the prognosis of patients with hypertension. Importantly, the variables associated with antihypertensive medication withdrawal do not occur immediately after the cessation, but likely in the following years. Nevertheless, since the current randomized clinical trials are limited to a short or mid follow-up, the results provided from these studies cannot exactly reflect the importance of the therapy discontinuation. We discuss about two recent examples, the ONTARGET and the TRANSCEND trials, in which the inclusion of the discontinuation rates in the primary analysis change the results of these studies and subsequently, the interpretation of the data. RR (95% CI) Primary endpoint (ONTARGET) Primary endpoint + discontinuation Telmisartan better Ramipril better Relative risk: 1.00 (95% CI 0.92, 1.09), P = 0.83 Relative risk: 0.95 (95% CI 0.89, 1.00), P = 0.08 0.8 0.9 1.0 1.1 1.2 Figure 1 Relative risk for primary end- points of ONTARGET trial and the rela- tive risk of the composite endpoint of primary endpoint plus discontinuation. ª 2009 The Authors Journal compilation ª 2009 Socie ´ te ´ Franc ¸aise de Pharmacologie et de The ´ rapeutique Fundamental & Clinical Pharmacology 23 (2009) 259–260 259