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Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites 2023; 13:1087. [PMID: 37887412 PMCID: PMC10609002 DOI: 10.3390/metabo13101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.
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Affiliation(s)
- Vittorio Venditti
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Enrico Bleve
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Susanna Morano
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Tiziana Filardi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
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Kim JD, Fisher A, Dormuth CR. Trends in antihypertensive drug utilization in British Columbia, 2004-2019: a descriptive study. CMAJ Open 2023; 11:E662-E671. [PMID: 37527901 PMCID: PMC10400081 DOI: 10.9778/cmajo.20220023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Clinical guidelines for hypertension were updated with lower blood pressure targets following new studies in 2015; the real-world impact of these changes on antihypertensive drug use is unknown. We aimed to describe trends in antihypertensive drug utilization from 2004 to 2019 in British Columbia. METHODS We conducted a longitudinal study to describe the annual prevalence and incidence rate of use of 5 antihypertensive drug classes (thiazides, angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], calcium channel blockers and β-blockers) among BC residents aged 30-75 years. We also conducted a cohort study to compare the risk of discontinuation and switch or add-on therapy between incident users of the above drug classes. We used linkable administrative health databases from BC. We performed a Fine-Gray competing risk analysis to estimate subhazard ratios. RESULTS Among BC residents aged 30-75 years (population: 2 376 282 [2004] to 3 014 273 [2019]), the incidence rate of antihypertensive drug use decreased from 23.7 per 1000 person-years in 2004 to 18.3 per 1000 person-years in 2014, and subsequently increased to 22.6 per 1000 person-years in 2019. The incidence rate of thiazide use decreased from 8.9 per 1000 person-years in 2004 to 3.2 per 1000 person-years in 2019, and incidence rates for the other drug classes increased. Incident users receiving thiazide monotherapy had an increased risk of discontinuing any antihypertensive treatment compared with ACE inhibitor monotherapy (subhazard ratio 0.96, 95% confidence interval [CI] 0.95-0.97), ARB monotherapy (subhazard ratio 0.84, 95% CI 0.81-0.87) and thiazide combination with ACE inhibitor or ARB (subhazard ratio 0.86, 95% CI 0.84-0.88), and had the highest risk of switching or adding on. INTERPRETATION First-line use of thiazides continued to decrease despite a marked increase in incident antihypertensive therapy following updated guidelines; incident users receiving ARB monotherapy were least likely to discontinue, and incident users receiving thiazide monotherapy were more likely to switch or add on than users of other initial monotherapy or combination. Further research is needed on the factors influencing treatment decisions to understand the differences in trends and patterns of antihypertensive drug use.
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Affiliation(s)
- Jason D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC
| | - Anat Fisher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC
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Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study. Sleep Med 2023; 104:113-120. [PMID: 36930993 DOI: 10.1016/j.sleep.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index ≥15 events/hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4-itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 ± 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15-2.82), lower monthly income (OR: 1.74; 95% IC:1.01-3.0) and EDS (OR: 1.63; 95% IC:1.05-2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.
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Abrahamowicz M, Beauchamp ME, Moura CS, Bernatsky S, Ferreira Guerra S, Danieli C. Adapting SIMEX to correct for bias due to interval-censored outcomes in survival analysis with time-varying exposure. Biom J 2022; 64:1467-1485. [PMID: 36065586 DOI: 10.1002/bimj.202100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/16/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022]
Abstract
Many clinical and epidemiological applications of survival analysis focus on interval-censored events that can be ascertained only at discrete times of clinic visits. This implies that the values of time-varying covariates are not correctly aligned with the true, unknown event times, inducing a bias in the estimated associations. To address this issue, we adapted the simulation-extrapolation (SIMEX) methodology, based on assessing how the estimates change with the artificially increased time between clinic visits. We propose diagnostics to choose the extrapolating function. In simulations, the SIMEX-corrected estimates reduced considerably the bias to the null and generally yielded a better bias/variance trade-off than conventional estimates. In a real-life pharmacoepidemiological application, the proposed method increased by 27% the excess hazard of the estimated association between a time-varying exposure, representing the 2-year cumulative duration of past use of a hypertensive medication, and the hazard of nonmelanoma skin cancer (interval-censored events). These simulation-based and real-life results suggest that the proposed SIMEX-based correction may help improve the accuracy of estimated associations between time-varying exposures and the hazard of interval-censored events in large cohort studies where the events are recorded only at relatively sparse times of clinic visits/assessments. However, these advantages may be less certain for smaller studies and/or weak associations.
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Affiliation(s)
- Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Eve Beauchamp
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Cristiano Soares Moura
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Sasha Bernatsky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Steve Ferreira Guerra
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Coraline Danieli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Treciokiene I, Bratcikoviene N, Gulbinovic J, Wettermark B, Taxis K. Non-persistence to antihypertensive drug therapy in Lithuania. Eur J Clin Pharmacol 2022; 78:1687-1696. [PMID: 35918539 PMCID: PMC9482566 DOI: 10.1007/s00228-022-03369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
Purpose Poor persistence to antihypertensive therapy is an important cause of treatment failure. Investigating persistence is especially important in countries with a high cardiovascular mortality, like Lithuania. The aim of this study was to describe the antihypertensive treatment at initiation, to determine the percentage of patients not being persistent with antihypertensive treatment after 1 year and to explore factors associated with non-persistence. Methods In this cohort study, data on dispensed prescription medicines from the Lithuanian National Health Insurance Fund (NHIF) were used. All adult patients with a diagnosis of hypertension having first antihypertensive dispensed in 2018 were included. Descriptive statistics was used to determine the number of patients started with monotherapy and combination therapy. Treatment choice by Anatomical Therapeutic Chemical (ATC) and number of active pharmaceutical ingredient (API) was described. Non-persistence was assessed using the anniversary method. Multivariate logistic regression was used to explore factors associated with non-persistence. Results A total of 72,088 patients were included into the study, 56% started on monotherapy treatment, with 49% being dispensed an angiotensin converting enzyme inhibitor, and 44% started on combination therapy. Overall, 57% of patients were non-persistent after 1 year. Patients’ gender and prescriber qualification showed no association with non-persistence. Younger patients, patients from rural area, patients started with monotherapy, and patients with no medication change had higher odds to become non-persistent. Conclusions The majority of patients were initiated with treatment following hypertension management guidelines, but it is of concern that over half of the patients were non-persistent to antihypertensive therapy in the first year.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, -Epidemiology & -Economics, Groningen, Netherlands. .,Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Nomeda Bratcikoviene
- Department of Mathematical Statistics, Faculty of Fundamental Sciences, Vilnius Tech, Vilnius, Lithuania.,Department of Human and Medical Genetics, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, -Epidemiology & -Economics, Groningen, Netherlands
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Impact of continuity of care on cardiovascular disease risk among newly-diagnosed hypertension patients. Sci Rep 2020; 10:19991. [PMID: 33203931 PMCID: PMC7672066 DOI: 10.1038/s41598-020-77131-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73–0.79), CHD (aHR 0.66, 95% CI 0.62–0.69) and stroke (aHR 0.84, 95% CI 0.80–0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.
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Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open 2020; 10:e036418. [PMID: 32641331 PMCID: PMC7348648 DOI: 10.1136/bmjopen-2019-036418] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Poor worldwide rate of blood pressure control is largely due to poor adherence to antihypertensive (AHT) drug treatment. The question of whether sex affects adherence has long been debated but conflicting findings have been reported on this issue. Our objective was to evaluate sex differences in the adherence to AHT therapy. RESEARCH DESIGN AND METHODS Studies were identified through a systematic search of PubMed, CINAHL, PsycINFO, Web of Science and Google Scholar (through January 2020) and manual handsearching of relevant articles. Observational studies reporting adherence to AHT drugs measured by self-report or pharmacy refill prescription-based methods among men and women were included. Summarised estimates of ORs with 95% CIs were calculated using random-effects model and meta-regression models. RESULTS From 12 849 potentially relevant publications, 82 studies (15 517 457 men and 18 537 599 women) were included. No significant between-sex differences in adherence to AHT were observed, whether all study-specific estimates were summarised (ORs 1.04, 95% CI 1.00 to 1.09, p=0.07), nor estimates were pooled according to the method for measuring adherence. Among patients aged 65 years or older, lower self-reported adherence was observed in women (ORs 0.84, 95% CI 0.72 to 0.97, p=0.02), while the main result remained unchanged according to other subgroup analyses. CONCLUSIONS Definitive evidence of sex differences in adherence to AHT therapy cannot be drawn. Our little knowledge about factors affecting adherence, in particular of sex effect among elderly, urgently requires high-quality studies investigating these issues.
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Affiliation(s)
- Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Federico Rea
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
| | - Teresa Iannaccone
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Amelia Filippelli
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Giuseppe Mancia
- University of Milan-Bicocca, Milano, Italy
- Policlinico di Monza, Monza, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy
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Nishimura S, Kumamaru H, Shoji S, Sawano M, Kohsaka S, Miyata H. Adherence to antihypertensive medication and its predictors among non-elderly adults in Japan. Hypertens Res 2020; 43:705-714. [DOI: 10.1038/s41440-020-0440-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 12/24/2022]
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Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands. PLoS One 2019; 14:e0225390. [PMID: 31730627 PMCID: PMC6857926 DOI: 10.1371/journal.pone.0225390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background Adherence to antihypertensive drugs in patients with diabetes is important. To support adherence, attention should be paid to the dynamic process of implementation, persistence and reinitiation of these drugs. We assessed non-adherence, non-persistence and reinitiation patterns for antihypertensive drugs in patients on oral diabetes drugs and identified pharmacy-based predictors of these processes. Methods We conducted a cohort study in patients on oral diabetes drugs who initiated antihypertensive drugs between 1995–2015, as registered in the IADB.nl pharmacy database. Non-adherence was defined as a medication possession ratio < 80% and non-persistence as a gap > 180 days. We defined reinitiation as the dispensing of an antihypertensive drug within one year following discontinuation. We provide descriptive statistics for different time periods and applied logistic and Cox regressions to assess associations with sociodemographic and drug-related factors. Results Of 6,669 initiators, non-adherence rates in persistent patients decreased from 11.0% in the first year to 8.5% and 7.7% in the second and third years, respectively. Non-persistence rates decreased from 18.0% in the first year to 3.7% and 2.9% in the second and third years, respectively. Of the 1,201 patients who discontinued in the first year, 22.0% reinitiated treatment within one year. Non-adherence and non-persistence rates were lower in the more recent time period. Predictors of non-adherence were secondary prevention (OR: 1.45; 95% CI: 1.10–1.93) and diuretics as initial drug class (OR: 1.37; 95% CI: 1.08–1.74). Predictors of non-persistence were female gender (HR: 1.18; 95% CI: 1.05–1.32), older age (HR: 1.33; 95% CI: 1.08–1.63) and diuretics, beta-blocking agents or calcium channel blockers as initial drug class. Longer duration of persistence was a predictor of reinitiation. Conclusions Adherence to antihypertensive drugs in patients on oral diabetes drugs has improved over time. The first year after initiation is the most crucial with regard to non-adherence and non-persistence, and the risk groups are different for both processes. Early non-persistence is a risk factor for not reinitiating treatment.
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Badin YV. [Tactical approaches to the treatment of arterial hypertension in the European part of the Russian Federation. EPOHA study 2017]. ACTA ACUST UNITED AC 2019; 59:77-84. [PMID: 31884944 DOI: 10.18087/cardio.n408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/21/2019] [Indexed: 11/18/2022]
Abstract
AIM Analysis of antihypertensive treatment among different groups of patients with arterial hypertension from "EPOCHA" study 2017. MATERIALS AND METHODS EPOCHA study is a representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2017. RESULTS 34.6% of the effectively treated (ET) patients had one antihypertensive drug and 32,2% of the ineffective treatment (IT) patients, p=0.16. Two-component antihypertensive therapy was 45.9% and 44.9%, respectively, p=0.56. Three antihypertensive drugs had 17.9% of the ET patients and 20.7% of the IT patients, p=0.05. Four antihypertensive drugs had 1.6% of the ET patients and 2.2% of the IT patients. The frequency of use of renin-angiotensin-aldosterone system blockers in the group of ET patients was 85.0%, which was significantly lower than 91.6% in the group of IT patients, р<0.0001. CONCLUSION EPOCHA study shows that structure of antihypertensive therapy does not differ between ET and IT patients what is caused lack of medical supervision for patients with hypertension in real clinical practice.
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Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Wettermark B. Medication persistence to antihypertensive drug treatment – a cross-sectional study of attitudes towards hypertension and medication in persistent and non-persistent patients. Blood Press 2019; 28:309-316. [DOI: 10.1080/08037051.2019.1627858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Miriam Qvarnström
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Björn Wettermark
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
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Su M, Haldane V, Upshur R, Sullivan F, Légaré F, Greiver M, Wei X. The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018. JMIR Res Protoc 2019; 8:e13571. [PMID: 31152529 PMCID: PMC6658229 DOI: 10.2196/13571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID) DERR1-10.2196/13571
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sullivan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of St Andrews, North Haugh, United Kingdom
| | - France Légaré
- Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Si S, Ofori-Asenso R, Briffa T, Sanfilippo FM, Ilomaki J, Qin X, Tacey M, Reid CM, Liew D. Long-term persistence and adherence to blood pressure lowering agents among older Australians. Pharmacoepidemiol Drug Saf 2019; 28:788-795. [DOI: 10.1002/pds.4742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/02/2018] [Accepted: 12/29/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine; Monash University; Melbourne Australia
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement; Curtin University; Perth Australia
| | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Tom Briffa
- School of Population and Global Health; University of Western Australia; Perth Australia
| | - Frank M. Sanfilippo
- School of Population and Global Health; University of Western Australia; Perth Australia
| | - Jenni Ilomaki
- Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Australia
| | - XiWen Qin
- School of Population and Global Health; University of Western Australia; Perth Australia
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Christopher M. Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine; Monash University; Melbourne Australia
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement; Curtin University; Perth Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine; Monash University; Melbourne Australia
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Peverelle MR, Baradi A, Paleri S, Lee YS, Sultani R, Toukhsati SR, Hare DL, Janus E, Wilson AM. Higher long-term adherence to statins in rural patients at high atherosclerotic risk. J Clin Lipidol 2019; 13:163-169. [DOI: 10.1016/j.jacl.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 01/17/2023]
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Uchmanowicz B, Chudiak A, Uchmanowicz I, Rosińczuk J, Froelicher ES. Factors influencing adherence to treatment in older adults with hypertension. Clin Interv Aging 2018; 13:2425-2441. [PMID: 30568434 PMCID: PMC6276633 DOI: 10.2147/cia.s182881] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Hypertension (HT) is considered to be the most common disorder in the general population. Demographic data indicate that older adults commonly suffer from HT. Older age is one of the key factors affecting the adherence of patients with HT. The main purpose was to identify demographic, socioeconomic, and clinical factors that affect adherence in older adults with HT. MATERIALS AND METHODS This cross-sectional study included 150 patients (84 women and 66 men) with mean age of 72.1 years. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) was used to evaluate the adherence to therapeutic recommendations for HT. RESULTS The mean score obtained by the patients in the Hill-Bone CHBPTS was 20.19 (SD±4.05). The linear regression model showed the independent predictors of the total score (P<0.05): 1) age, each subsequent year of life raises the total score by an average of 0.2 points; 2) gender, males raise it by an average of 1.34 points compared to females; 3) education, a secondary, higher, or higher professional education lowers it by an average of 1.75 points compared to a primary education or no education; and 4) living with the family, having familial support lowers it by an average of 1.91 points compared to living alone or in an organized institution. CONCLUSION Our study has shown that the variables of age, education level, and living with the family were statistically significant in explaining the adherence rates. Health care professionals should pay more attention to older HT patients who have a low level of education and who experience the lack of social support. There is a need for a tailored education among this group of patients to better understand and adhere to medication treatment.
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Affiliation(s)
- Bartosz Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Anna Chudiak
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland,
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Exploring factors associated with patients' adherence to antihypertensive drugs among people with primary hypertension in the United Kingdom. J Hypertens 2018; 35:1881-1890. [PMID: 28441185 DOI: 10.1097/hjh.0000000000001382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To explore factors associated with adherence to antihypertensive drugs overall (therapy adherence) and to particular classes (class adherence) in hypertensive patients. METHODS The current retrospective cohort study included adults with primary hypertension identified in the UK Clinical Practice Research Datalink from April 2006 to March 2013. Individuals were followed from the date of first-ever antihypertensive drug class (class adherence) prescribed and from the date of the first-ever antihypertensive drug (therapy adherence) issued to the earliest of study end, patient leaving the database, or death. Prescribing episodes (time from a drug class being first prescribed to the end of follow-up time) of six antihypertensive drug classes were recorded. Proportion of days covered (PDC) was used to estimate therapeutic adherence for a patient's antihypertensive drugs therapy during follow-up period and class adherence of a specific antihypertensive class in each episode, respectively. Generalized linear modelling was used to examine factors associated with PDC. RESULTS Median therapy and class PDC were 93.9 and 98.3% in the 176 835 patients and 371 605 prescribing episodes; 20 and 38.4% of the patients and episodes had PDC less than 80%, respectively. Higher therapy and class PDC was associated with increasing age, using renin angiotensin drugs, and being preexisting patient and user of antihypertensive drugs. Higher deprivation, multiple comorbidities, and switching of antihypertensive drugs were associated with lower PDC. CONCLUSION Several patient factors were confirmed as determinant of adherence to antihypertensive drug classes and therapy; hence, they can assist in identifying patients at risks of nonadherence, thus targeting them for adherence improving interventions.
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Holmqvist L, Boström KB, Kahan T, Schiöler L, Qvarnström M, Wettermark B, Hjerpe P, Hasselström J, Manhem K. Drug adherence in treatment resistant and in controlled hypertension-Results from the Swedish Primary Care Cardiovascular Database (SPCCD). Pharmacoepidemiol Drug Saf 2018; 27:315-321. [DOI: 10.1002/pds.4388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Lina Holmqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Internal Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
| | | | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - Linus Schiöler
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Miriam Qvarnström
- Department of Medicine, Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
| | - Björn Wettermark
- Department of Medicine, Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
- Public Healthcare Services Committee; Stockholm County Council; Stockholm Sweden
| | - Per Hjerpe
- Närhälsan R&D Centre Skaraborg Primary Care; Skövde Sweden
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine; Karolinska Institutet; Stockholm Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Internal Medicine; Sahlgrenska University Hospital; Gothenburg Sweden
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18
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Choi KH, Yu YM, Ah YM, Chang MJ, Lee JY. Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:232. [PMID: 28836946 PMCID: PMC5571581 DOI: 10.1186/s12872-017-0665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the medication-taking behavior in very elderly hypertensive patients. The aim of this study was to evaluate the persistence and adherence with antihypertensive agents in treatment-naïve patients, along with other related factors, according to age. METHODS Adult (19-64 years), elderly (65-79 years), and very elderly (≥80 years) uncomplicated hypertensive patients starting antihypertensive monotherapy were identified from the National Health Insurance claims database. The first-year treatment persistence and adherence rates measured using the medication possession ratio were assessed and compared in these three age cohorts. RESULTS After propensity score matching, three age cohorts with 6689 patients each were assembled from 228,925 uncomplicated hypertensive patients who began antihypertensive monotherapy in 2012. The treatment persistence and adherence rates over the first year were the lowest in the very elderly (59.5% and 62.8%, respectively) and highest in the elderly (65.2% and 67.9%, respectively) patients among the three age cohorts (p < 0.001). The adjusted risk for treatment non-persistence was significantly higher in the very elderly (adjusted hazard ratio, 1.20; 95% confidence interval, 1.13-1.27) compared with the elderly. Having more comorbidities, being a beneficiary of medical aid, and having a diagnosis of dementia were unique positive predictors for treatment persistence in the very elderly, along with common predictors such as female sex, dyslipidemia, and an initially chosen antihypertensive therapeutic class other than beta blockers and thiazide diuretics. CONCLUSIONS Very elderly patients were less likely to continue antihypertensive therapy over the first year compared with their younger counterparts. Our findings suggest that a low comorbidity index and lack of medical aid support negatively affect the treatment persistence in this population.
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Affiliation(s)
- Kyung Hee Choi
- College of Pharmacy, Sunchon National University, 255 Jungang-ro, Suncheon, Jeollanam-do, 57922, South Korea.,College of Pharmacy, Chonnam National University, Gwang-Ju, 61186, South Korea
| | - Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea
| | - Min Jung Chang
- College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, 21983, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea.
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Machado MADÁ, de Moura CS, Wang Y, Danieli C, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Comparative effectiveness of antihypertensive drugs in nondiabetic patients with hypertension: A population-based study. J Clin Hypertens (Greenwich) 2017; 19:999-1009. [PMID: 28755451 DOI: 10.1111/jch.13055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/27/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022]
Abstract
The authors compared the effectiveness of thiazide diuretic (TD), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), and calcium channel blocker (CCB) monotherapies for the treatment of nondiabetic hypertension using MarketScan Databases 2010-2014. Multivariable Cox regression models assessed whether the addition of a new antihypertensive drug, treatment discontinuation, or switch and major cardiovascular or cerebrovascular events varied across groups. A total of 565 009 patients started monotherapy with ACEIs (43.6%), CCBs (23.6%), TDs (18.8%), or ARBs (14.0%). Patients who took TDs had a higher risk for either drug addition or discontinuation than patients who took ACEIs (hazard ratio [HR], 0.69 [95% CI, 0.68-0.70] vs HR, 0.81 [95% CI, 0.80-0.81]), ARBs (HR, 0.67 [95% CI, 0.66-0.68] vs HR, 0.66 [95% CI, 0.65-0.67]), and CCBs (HR, 0.85 [95% CI, 0.84-0.87] vs HR, 0.94 [95% CI, 0.93-0.95]). Conversely, patients who took TDs experienced a lower risk of clinical events compared with patients who took ACEIs (HR, 1.24 [95% CI, 1.15-1.33]), ARBs (HR, 1.28 [95% CI, 1.18-1.39]), and CCBs (HR, 1.35 [95% CI, 1.25-1.46]). Our results provide a strong rationale for choosing TDs as first-line monotherapy for the control of hypertension.
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Affiliation(s)
| | - Cristiano Soares de Moura
- Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada
| | - Yishu Wang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Coraline Danieli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Division of Clinical Epidemiology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
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Dumitrescu L, Ritchie MD, Denny JC, El Rouby NM, McDonough CW, Bradford Y, Ramirez AH, Bielinski SJ, Basford MA, Chai HS, Peissig P, Carrell D, Pathak J, Rasmussen LV, Wang X, Pacheco JA, Kho AN, Hayes MG, Matsumoto M, Smith ME, Li R, Cooper-DeHoff RM, Kullo IJ, Chute CG, Chisholm RL, Jarvik GP, Larson EB, Carey D, McCarty CA, Williams MS, Roden DM, Bottinger E, Johnson JA, de Andrade M, Crawford DC. Genome-wide study of resistant hypertension identified from electronic health records. PLoS One 2017; 12:e0171745. [PMID: 28222112 PMCID: PMC5319785 DOI: 10.1371/journal.pone.0171745] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/25/2017] [Indexed: 12/11/2022] Open
Abstract
Resistant hypertension is defined as high blood pressure that remains above treatment goals in spite of the concurrent use of three antihypertensive agents from different classes. Despite the important health consequences of resistant hypertension, few studies of resistant hypertension have been conducted. To perform a genome-wide association study for resistant hypertension, we defined and identified cases of resistant hypertension and hypertensives with treated, controlled hypertension among >47,500 adults residing in the US linked to electronic health records (EHRs) and genotyped as part of the electronic MEdical Records & GEnomics (eMERGE) Network. Electronic selection logic using billing codes, laboratory values, text queries, and medication records was used to identify resistant hypertension cases and controls at each site, and a total of 3,006 cases of resistant hypertension and 876 controlled hypertensives were identified among eMERGE Phase I and II sites. After imputation and quality control, a total of 2,530,150 SNPs were tested for an association among 2,830 multi-ethnic cases of resistant hypertension and 876 controlled hypertensives. No test of association was genome-wide significant in the full dataset or in the dataset limited to European American cases (n = 1,719) and controls (n = 708). The most significant finding was CLNK rs13144136 at p = 1.00x10-6 (odds ratio = 0.68; 95% CI = 0.58–0.80) in the full dataset with similar results in the European American only dataset. We also examined whether SNPs known to influence blood pressure or hypertension also influenced resistant hypertension. None was significant after correction for multiple testing. These data highlight both the difficulties and the potential utility of EHR-linked genomic data to study clinically-relevant traits such as resistant hypertension.
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Affiliation(s)
- Logan Dumitrescu
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Marylyn D. Ritchie
- Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Nihal M. El Rouby
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Caitrin W. McDonough
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Yuki Bradford
- Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Andrea H. Ramirez
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Suzette J. Bielinski
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa A. Basford
- Office of Research, Vanderbilt University, Nashville, Tennessee, United States of America
| | - High Seng Chai
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Peggy Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - David Carrell
- Group Health Research Institute, Seattle, Washington, United States of America
| | - Jyotishman Pathak
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Luke V. Rasmussen
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Northwestern University, Chicago, Illinois, United States of America
| | - Xiaoming Wang
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jennifer A. Pacheco
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Abel N. Kho
- Department Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Geoffrey Hayes
- Department Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Martha Matsumoto
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Maureen E. Smith
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland, United States of America
| | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Iftikhar J. Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher G. Chute
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rex L. Chisholm
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Gail P. Jarvik
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, United States of America
| | - Eric B. Larson
- Group Health Research Institute, Seattle, Washington, United States of America
| | - David Carey
- Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America
| | | | - Marc S. Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Erwin Bottinger
- Charles R. Bronfman Institute for Personalized Medicine, Mount Sinai, New York, New York, United States of America
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dana C. Crawford
- Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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21
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Degli Esposti L, Sangiorgi D, Buda S, Degli Esposti E, Scaglione F. Therapy discontinuation or substitution in patients with cardiovascular disease, switching among different products of the same off-patent active substance: a 'real-world' retrospective cohort study. BMJ Open 2016; 6:e012003. [PMID: 27807083 PMCID: PMC5129038 DOI: 10.1136/bmjopen-2016-012003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The present study investigated the effects of switching to different products of the same off-patent active substance (brand name or generic) on therapy discontinuation or substitution with another molecule of the same class, in patients with cardiovascular disease treated with statins and antihypertensives in a 'real-world' setting. DESIGN A retrospective cohort study in a 'real-world' setting. SETTING Analysis of data performed by integrating administrative databases that included approximately two million individuals who are assisted by the National Health System from three Local Health Units located in three different regions of Italy. PARTICIPANTS All patients aged ≥18 years with at least one prescription of simvastatin, ramipril or amlodipine in the period 1 January to 31 December 2010 were included and followed up for 2 years. MAIN OUTCOME MEASURES Prescription refills occurring during follow-up were evaluated. Frequency of discontinuation of therapy or substitution with another molecule of the same class (eg, from simvastatin to a different statin) during follow-up was identified. RESULTS During follow-up, therapy discontinuation or substitution was found to be more frequent in patients switching to a different product of the same active substance compared with non-switching patients (11.5% vs 10.8% and 22.2% vs 20.8% (p=0.002), respectively, in the simvastatin group; 4.0% vs 3.5% and 24.6% vs 22.7% (p<0.001), respectively, in the amlodipine group). In the ramipril group, 8% of patients undertook a therapy substitution to another molecule; no trend towards a lower percentage of substitution was observed in the non-switching group, while 18% of patients discontinued treatment, with a significant difference in favour of patients not switching. These findings were partially confirmed by multivariate analysis. CONCLUSIONS Switches among products of the same active substance are quite common in patients with cardiovascular disease. Our study suggests that switching may expose patients to a higher risk of therapy discontinuation or substitution.
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Affiliation(s)
| | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | | | - Francesco Scaglione
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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22
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Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Boström KB, Manhem K, Hjerpe P, Wettermark B. Persistence to antihypertensive drug classes: A cohort study using the Swedish Primary Care Cardiovascular Database (SPCCD). Medicine (Baltimore) 2016; 95:e4908. [PMID: 27749548 PMCID: PMC5059050 DOI: 10.1097/md.0000000000004908] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim was to study persistence to, and switching between, antihypertensive drug classes and to determine factors associated with poor persistence.This was an observational cohort study. The Swedish Primary Care Cardiovascular Database includes data from medical records, socioeconomic data, filled prescriptions, and hospitalizations from national registries for 75,000 patients with hypertension. Patients included in the study were initiated on antihypertensive drug treatment in primary healthcare in 2006 to 2007. We defined class persistence as the proportion remaining on the initial drug class, including 30 days of gap. Patients with a filled prescription of another antihypertensive drug class after discontinuation of the initial drug, including 30 days of gap, were classified as switchers. Persistence to the various drug classes were compared with that for diuretics.We identified 4997 patients (mean age 60 ± 12 years in men and 63 ± 13 years in women). Out of these, 95 (2%) filled their first prescription for fixed combination therapy and 4902 (98%) for monotherapy, including angiotensin converting enzyme inhibitors (37%), angiotensin receptor blockers (4%), beta blockers (21%), calcium channel blockers (8%), and diuretics (28%). Persistence to the initial drug class was 57% after 1 year and 43% after 2 years. There were no differences in persistence between diuretics and any of the other antihypertensive drug classes, after adjustment for confounders. Discontinuation (all adjusted) was more common in men (P = 0.004), younger patients (P < 0.001), those with mild systolic blood pressure elevation (P < 0.001), and patients born outside the Nordic countries (P < 0.001). Among 1295 patients who switched drug class after their first prescription, only 21% had a blood pressure recorded before the switch occurred; and out them 69% still had high blood pressures.In conclusion, there appears to be no difference in drug class persistence between diuretics and other major antihypertensive drug classes, when factors known to be associated with poor persistence are taken into account.
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Affiliation(s)
- Miriam Qvarnström
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
- Correspondence: Miriam Qvarnström, Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet, Solna, T2, Karolinska University Hospital, SE-171 76 Stockholm, Sweden (e-mail: )
| | - Thomas Kahan
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet
| | - Helle Kieler
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
| | - Lena Brandt
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Stockholm
| | | | - Karin Manhem
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Per Hjerpe
- Närhälsan R&D Primary Care, R&D-Center Skaraborg, Skövde
| | - Björn Wettermark
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institutet
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
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23
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Schulz M, Krueger K, Schuessel K, Friedland K, Laufs U, Mueller WE, Ude M. Medication adherence and persistence according to different antihypertensive drug classes: A retrospective cohort study of 255,500 patients. Int J Cardiol 2016; 220:668-76. [PMID: 27393848 DOI: 10.1016/j.ijcard.2016.06.263] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/19/2016] [Accepted: 06/27/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Suboptimal adherence to antihypertensives leads to adverse clinical outcomes. This study aims to determine and compare medication adherence and persistence to different first-line antihypertensive drug classes in a large cohort. METHODS A cohort study was performed using claims data for prescriptions in the German statutory health insurance scheme that insures approximately 90% of the population. A total of 255,500 patients with a first prescription of an antihypertensive were included and followed for 24months. Persistence was determined based on gaps in continuous dispensation. Adherence was analyzed by calculating the medication possession ratio (MPR). RESULTS Within a 2-year period, 79.3% of all incident users of antihypertensive monotherapy met the classification of non-persistence (gap >0.5 times the number of days supplied with medication) and 56.3% of non-adherence (MPR<0.8). Beta-blockers (42.5%) and angiotensin-converting enzyme inhibitors (31.9%) were the most widely prescribed drug classes. Non-persistence and non-adherence were highest for diuretics (85.4%, n=6149 and 66.3%, n=4774) and lowest for beta-blockers (77.6%, n=76,729 and 55.2%, n=54,559). The first gap of antihypertensive medication occurred in median 160-250days after initiation, and the average medication possession ratio for all drug classes was less than 0.8. Fixed combinations with diuretics showed a 19.8% lower chance for non-adherence (OR=0.802, 99.9% CI=[0.715-0.900], p<0.001) and an 8.4% lower hazard for non-persistence (HR 0.916, 99.9% CI=[0.863-0.973], p<0.001) compared with monotherapies. CONCLUSIONS This large cohort study reveals important differences in 2-year adherence and persistence between antihypertensives that were lowest for diuretics. Fixed-dose combinations with diuretics may facilitate adherence compared to single substance products. However, effective strategies to improve adherence to antihypertensives are needed regardless of drug class.
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Affiliation(s)
- Martin Schulz
- DAPI-German Institute for Drug Use Evaluation, Unter den Linden 19-23, 10117 Berlin, Germany; Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Unter den Linden 19-23, 10117 Berlin, Germany; Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Max-von-Laue-Strasse 9, 60438 Frankfurt am Main, Germany; Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Kelchstrasse 31, 12169, Berlin, Germany.
| | - Katrin Krueger
- Department of Medicine, ABDA-Federal Union of German Associations of Pharmacists, Unter den Linden 19-23, 10117 Berlin, Germany
| | - Katrin Schuessel
- DAPI-German Institute for Drug Use Evaluation, Unter den Linden 19-23, 10117 Berlin, Germany
| | - Kristina Friedland
- Molecular and Clinical Pharmacy, Department of Chemistry and Pharmacy, Friedrich-Alexander-Universitaet Erlangen/Nuremberg, Cauerstrasse 4, 91058 Erlangen, Germany
| | - Ulrich Laufs
- Department of Internal Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421 Homburg/Saar, Germany
| | - Walter E Mueller
- Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Max-von-Laue-Strasse 9, 60438 Frankfurt am Main, Germany
| | - Miriam Ude
- DAPI-German Institute for Drug Use Evaluation, Unter den Linden 19-23, 10117 Berlin, Germany; Department of Pharmacology, Biocenter, Goethe-University Frankfurt, Max-von-Laue-Strasse 9, 60438 Frankfurt am Main, Germany
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Kim HJ, Yoon SJ, Oh IH, Lim JH, Kim YA. Medication Adherence and the Occurrence of Complications in Patients with Newly Diagnosed Hypertension. Korean Circ J 2016; 46:384-93. [PMID: 27275175 PMCID: PMC4891603 DOI: 10.4070/kcj.2016.46.3.384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/08/2015] [Accepted: 11/17/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In this retrospective cohort study, we sought to elucidate the relationship between medication adherence (MA) and the incidence of complications in patients with newly diagnosed hypertension. SUBJECTS AND METHODS Using claims data from the National Health Insurance Service, we measured health outcomes based on levels of MA, analyzed the incidence of complications in patients with a good MA, and clarified factors that may affect or predict MA. RESULTS In 2008, a total of 4294773 patients were diagnosed with hypertension and were subsequently prescribed anti-hypertensive medications. In the present study, we enrolled 564782 patients who met our inclusion/exclusion criteria. The 40-59% medication possession ratio (MPR) group had a 1.36 times higher risk of developing complications (95% confidence interval [CI]: 1.27-1.45) than did the MPR≥ 80% group, as revealed through Cox's proportional hazards analysis. Similarly, the <20% MPR group was 2.01 times more likely to develop complications than the good MA group (95% CI: 1.82-2.23). Overall, patients who had a lower level of MA had a higher risk of developing complications. CONCLUSION Our results demonstrate that MA is tightly correlated with hypertension health outcomes. Improving MA could be one strategy for reducing the risk of cerebrovascular disease complications and the loss of productivity in these patients.
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Affiliation(s)
- Hyun-Jin Kim
- Department of Rehabilitation Standard & Policy, Korea National Rehabilitation Research Institute, Seoul, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jae Hee Lim
- Department of Preventive Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Martins RR, Duarte Farias A, Russel Martins R, Gouveia Oliveira A. Influence of the use of medicinal plants in medication adherence in elderly people. Int J Clin Pract 2016; 70:254-60. [PMID: 26799730 DOI: 10.1111/ijcp.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the relationship between the use of medicinal plants and medication adherence in elderly people. METHODS Observational, cross-sectional study of elderly residents in Cuité-PB, Northeastern Brazil, through a household survey. A stratified proportional and systematic random sample of 240 elders was interviewed in their homes and the use of pharmaceutical medicines and of medicinal plants was assessed by direct examination. The association of medication adherence with socio-demographic, clinical, medication and use of medicinal plants was analysed with multiple logistic regression. RESULTS The results showed that medication non-adherence increases with use of herbal medicines (adjusted odds ratio 2.022, 95% CI 1.059-3.862, p = 0.03), as well as with the number of different medicinal plants used (adjusted odds ratio 1.937, 95% CI 1.265-2.965, p = 0.002). CONCLUSION/INTERPRETATION This study provides first-hand evidence that the use of herbal medicines is associated with poor medication adherence. Given the high frequency of the use of herbal medicines, further research into the mechanisms of this association is justified.
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Affiliation(s)
- R R Martins
- Pharmacy Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - A Duarte Farias
- Pharmacy Department, Federal University of Campina Grande, Campina Grande, Brazil
| | - R Russel Martins
- Department of Social Sciences, Federal University of Semi-Arido, Mossoró, Brazil
| | - A Gouveia Oliveira
- Pharmacy Department, Federal University of Rio Grande do Norte, Natal, Brazil
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Calderón-Larrañaga A, Diaz E, Poblador-Plou B, Gimeno-Feliu LA, Abad-Díez JM, Prados-Torres A. Non-adherence to antihypertensive medication: The role of mental and physical comorbidity. Int J Cardiol 2016; 207:310-6. [PMID: 26814635 DOI: 10.1016/j.ijcard.2016.01.069] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/15/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multiple parameters influence adherence to drug treatment, including socio-economic, healthcare, condition, therapy, and patient-related factors. However, studies of the impact of patient-related factors, particularly regarding comorbid conditions, have produced conflicting results. OBJECTIVES To analyse the association between mental and physical comorbidity and non-adherence to antihypertensive medication in patients attending primary care, after including a comprehensive range of chronic comorbidities and potential confounders. METHODS Cross-sectional study of 113,397 adults with a diagnosis of hypertension in 2010 assigned to the public health service of a region in northeastern Spain. Pharmacy billing records were linked to data from electronic health records at individual level. Non-adherence was defined as an antihypertensive medication possession ratio (MPR) <80%. Multivariable logistic regression models were used to estimate the odds ratio for non-adherence. Potential predictors included mental and physical comorbidity, age, sex, blood pressure level, nationality, rurality, polypharmacy, and number of visits to the GP and to different specialties. RESULTS One fifth of the study population showed poor adherence levels. Female sex, younger age, foreign nationality, living in a rural area, low blood pressure levels, polypharmacy, and mental comorbidity were positively and significantly associated with non-adherence. Conversely, non-adherence was negatively and significantly associated with the presence of cardiovascular risk factors and higher annual rates of GP visits. CONCLUSION The majority of patient-related determinants identified here (e.g., the presence of mental comorbidity, polypharmacy, foreign nationality) underscores the need for a patient- rather than a disease-centred care approach, as well as adequate physician-patient communication.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, NO-5020 Bergen, Norway; Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, PO box 4956, NO-0424 Oslo, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - Luis Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; San Pablo Health Centre, C/ Aguadores 7, 50003 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain
| | - José María Abad-Díez
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain; Dpt. of Health, Welfare and Family, DG Planning and Assurance, Government of Aragon, Vía Univérsitas 36, 50009 Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain
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Ah YM, Lee JY, Choi YJ, Kim B, Choi KH, Kong J, Oh JM, Shin WG, Lee HY. Persistence with Antihypertensive Medications in Uncomplicated Treatment-Naïve Patients: Effects of Initial Therapeutic Classes. J Korean Med Sci 2015; 30:1800-6. [PMID: 26713055 PMCID: PMC4689824 DOI: 10.3346/jkms.2015.30.12.1800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Abstract
We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.
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Affiliation(s)
- Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Yun-Jung Choi
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Baegeum Kim
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea
| | - Kyung Hee Choi
- College of Pharmacy, Sunchon National University, Suncheon, Korea
| | - Jisun Kong
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Jung Mi Oh
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Wan Gyoon Shin
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Saadat Z, Nikdoust F, Aerab-Sheibani H, Bahremand M, Shobeiri E, Saadat H, Moharramzad Y, Morisky DE. Adherence to Antihypertensives in Patients With Comorbid Condition. Nephrourol Mon 2015; 7:e29863. [PMID: 26539419 PMCID: PMC4628207 DOI: 10.5812/numonthly.29863] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/28/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. OBJECTIVES We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. PATIENTS AND METHODS Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. RESULTS The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. CONCLUSIONS With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.
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Affiliation(s)
- Zahra Saadat
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farahnaz Nikdoust
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Aerab-Sheibani
- Department of Cardiology, Shahid Sadoughi University of Medical Sciences, Bafgh,Kermanshah, IR Iran
| | - Mostafa Bahremand
- Department of Cardiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Mostafa Bahremand, Department of Cardiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-8338360014, E-mail:
| | - Elham Shobeiri
- Department of Radiology, Kermanshah University of Medical Sciences,Kermanshah, IR Iran
| | - Habibollah Saadat
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Yashar Moharramzad
- Department of Cardiology, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Donald E. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, USA
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Cordero A, Bertomeu-Martínez V, Mazón P, Fácila L, González-Juanatey JR. Erectile Dysfunction May Improve by Blood Pressure Control in Patients with High-Risk Hypertension. Postgrad Med 2015; 122:51-6. [DOI: 10.3810/pgm.2010.11.2223] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Liu Q, Quan H, Chen G, Qian H, Khan N. Antihypertensive Medication Adherence and Mortality According to Ethnicity: A Cohort Study. Can J Cardiol 2014; 30:925-31. [DOI: 10.1016/j.cjca.2014.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/17/2014] [Accepted: 04/04/2014] [Indexed: 11/24/2022] Open
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Cardiovascular medication utilization and adherence among adults living in rural and urban areas: a systematic review and meta-analysis. BMC Public Health 2014; 14:544. [PMID: 24888355 PMCID: PMC4064809 DOI: 10.1186/1471-2458-14-544] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 05/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural residents face numerous barriers to healthcare access and studies suggest poorer health outcomes for rural patients. Therefore we undertook a systematic review to determine if cardiovascular medication utilization and adherence patterns differ for rural versus urban patients. METHODS A comprehensive search of major electronic datasets was undertaken for controlled clinical trials and observational studies comparing utilization or adherence to cardiovascular medications in rural versus urban adults with cardiovascular disease or diabetes. Two reviewers independently identified citations, extracted data, and evaluated quality using the STROBE checklist. Risk estimates were abstracted and pooled where appropriate using random effects models. Methods and reporting were in accordance with MOOSE guidelines. RESULTS Fifty-one studies were included of fair to good quality (median STROBE score 17.5). Although pooled unadjusted analyses suggested that patients in rural areas were less likely to receive evidence-based cardiovascular medications (23 studies, OR 0.88, 95% CI 0.79, 0.98), pooled data from 21 studies adjusted for potential confounders indicated no rural-urban differences (adjusted OR 1.02, 95% CI 0.91, 1.13). The high heterogeneity observed (I(2) = 97%) was partially explained by treatment setting (hospital, ambulatory care, or community-based sample), age, and disease. Adherence did not differ between urban versus rural patients (3 studies, OR 0.94, 95% CI 0.39, 2.27, I(2) = 91%). CONCLUSIONS We found no consistent differences in rates of cardiovascular medication utilization or adherence among adults with cardiovascular disease or diabetes living in rural versus urban settings. Higher quality evidence is needed to determine if differences truly exist between urban and rural patients in the use of, and adherence to, evidence-based medications.
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Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension. Heart Lung 2014; 43:278-83. [PMID: 24856232 DOI: 10.1016/j.hrtlng.2014.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/02/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the factors that influence medication adherence in Chinese community-dwelling older adults with hypertension. METHODS A cross-sectional study was conducted with a convenience sample of 382 older adults with hypertension recruited from six health centers in Macao, China. Chinese versions of the Morisky 4-Item Self-Report Measure of Medication-Taking Behavior, Fear of Intimacy with Helping Professionals scale and Exercise of Self-care Agency scale were administered to participants. RESULTS Participants older than 65 years (β = .118, p = .017), with a low level of education (β = .128, p = .01), who had more than one other common disease (β = .120, p = .015), were on long-term medication (β = .221, p < .001) and who reported higher self-care (β = .188, p = .001), had better medication adherence. CONCLUSIONS Health care professionals should consider these factors when planning medication regimens for Chinese older adults with hypertension, to enhance medication adherence and improve patient outcomes.
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Cho SJ, Kim J. Factors associated with nonadherence to antihypertensive medication. Nurs Health Sci 2014; 16:461-7. [DOI: 10.1111/nhs.12145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Su-Jin Cho
- College of Nursing; Seoul National University; Seoul Korea
| | - Jinhyun Kim
- College of Nursing; Seoul National University; Seoul Korea
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Christe V, Waeber G, Vollenweider P, Marques-Vidal P. Antihypertensive drug treatment changes in the general population: the CoLaus study. BMC Pharmacol Toxicol 2014; 15:20. [PMID: 24685255 PMCID: PMC4021828 DOI: 10.1186/2050-6511-15-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/26/2014] [Indexed: 12/31/2022] Open
Abstract
Background Changes in antihypertensive drug treatment are paramount in the adequate management of patients with hypertension, still, there is little information regarding changes in antihypertensive drug treatment in Switzerland. Our aim was to assess those changes and associated factors in a population-based, prospective study. Methods Data from the population-based, CoLaus study, conducted among subjects initially aged 35–75 years and living in Lausanne, Switzerland. 772 hypertensive subjects (371 women) were followed for a median of 5.4 years. Data Subjects were defined as continuers (no change), switchers (one antihypertensive class replaced by another), combiners (one antihypertensive class added) and discontinuers (stopped treatment). The distribution and the factors associated with changes in antihypertensive drug treatment were assessed. Results During the study period, the prescription of diuretics decreased and of ARBs increased: at baseline, diuretics were taken by 46.9% of patients; angiotensin receptor blockers (ARB) by 44.7%, angiotensin converting enzyme inhibitors (ACEI) by 28.8%, beta-blockers (BB) by 28.0%, calcium channel blockers (CCB) by 18.9% and other antihypertensive drugs by 0.3%. At follow-up (approximately 5 years later), their corresponding percentages were 42.8%, 51.7%, 25.5%, 33.0% 20.7% and 1.0%. Among all participants, 54.4% (95% confidence interval: 50.8-58.0) were continuers, 26.9% (23.8-30.2) combiners, 12.7% (10.4-15.3) switchers and 6.0% (4.4-7.9) discontinuers. Combiners had higher systolic blood pressure values at baseline than the other groups (p < 0.05). Almost one third (30.6%) of switchers and 29.3% of combiners improved their blood pressure status at follow-up, versus 18.8% of continuers and 8.7% of discontinuers (p < 0.001). Conversely, almost one third (28.3%) of discontinuers became hypertensive (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), vs. 22.1% of continuers, 16.3% of switchers and 11.5% of combiners (p < 0.001). Multivariate analysis showed baseline uncontrolled hypertension, ARBs, drug regimen (monotherapy/polytherapy) and overweight/obesity to be associated with changes in antihypertensive therapy. Conclusion In Switzerland, ARBs have replaced diuretics as the most commonly prescribed antihypertensive drug. Uncontrolled hypertension, ARBs, drug regimen (monotherapy or polytherapy) and overweight/obesity are associated with changes in antihypertensive treatment.
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Affiliation(s)
| | | | | | - Pedro Marques-Vidal
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010 Lausanne, Switzerland.
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Tu K, Anderson LN, Butt DA, Quan H, Hemmelgarn BR, Campbell NR, McAlister FA. Antihypertensive drug prescribing and persistence among new elderly users: implications for persistence improvement interventions. Can J Cardiol 2014; 30:647-52. [PMID: 24882536 DOI: 10.1016/j.cjca.2014.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/07/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The objective of this study was to examine persistence rates and factors influencing persistence for new elderly users of antihypertensive drugs. METHODS We conducted a population-based cohort study in Ontario of adults aged 66 years or older to identify new users of antihypertensive medications between 1999 and 2010. Two-year therapy and class persistence were defined as persistence on any antihypertensive medication and persistence only on the same antihypertensive medication class, respectively. RESULTS From 1999-2010, the prevalence of antihypertensive drug use increased from 47.8%-60.5% (P < 0.0001). Persistence was evaluated in 420,148 new users of antihypertensive drugs. After 2 years, therapy persistence was 58.9% and varied according to initial class prescribed, from 52.3% for diuretics to 64.1% for angiotensin-converting enzyme inhibitors. Class persistence ranged from 25.3% for diuretics to 35.8% for angiotensin II receptor blockers. Therapy persistence rates were greater in new users from more recent years (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.21-1.27). Subgroups that demonstrated poorer persistence included patients older than 75 years (aOR, 0.95; 95% CI, 0.94-0.96), those with lowest neighbourhood income quintile (aOR, 0.81; 95% CI, 0.80-0.83 compared with the highest quintile), those from urban vs rural areas (aOR, 0.83; 95% CI, 0.81-0.84), and those who started on diuretics as initial monotherapy compared with all other drug classes. CONCLUSIONS Although 2-year therapy and class persistence were low for new users of antihypertensive drugs, improvements have occurred over the past decade. Our data highlight subgroups to target for future persistence improvement interventions.
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Affiliation(s)
- Karen Tu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network-Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada.
| | - Laura N Anderson
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Debra A Butt
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Norm R Campbell
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Alsabbagh MHDW, Lemstra M, Eurich D, Lix LM, Wilson TW, Watson E, Blackburn DF. Socioeconomic status and nonadherence to antihypertensive drugs: a systematic review and meta-analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:288-96. [PMID: 24636389 DOI: 10.1016/j.jval.2013.11.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/30/2013] [Accepted: 11/30/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND Although conventional wisdom suggests that low socioeconomic status (SES) is a robust predictor of medication nonadherence, the strength of this association remains unclear. OBJECTIVES 1) To estimate the proportion of studies that identified SES as a potential risk indicator of nonadherence, 2) to describe the type of SES measurements, and 3) to quantify the association between SES and nonadherence to antihypertensive pharmacotherapy. METHODS A systematic review and meta-analysis research design was used. We searched multiple electronic databases for studies in English or French examining nonadherence to antihypertensive medications measured by electronic prescription databases where explanatory factors were considered. Two authors independently assessed quality, described the SES measure(s), and recorded its association with nonadherence to antihypertensives. A random-effects model meta-analysis was performed, and heterogeneity was examined by using the I(2) statistic. RESULTS Fifty-six studies with 4,780,293 subjects met the inclusion criteria. Twenty-four of these studies (43%) did not report any SES measures. When it was reported (n = 32), only seven (13%) examined more than one component but none performed a multidimensional assessment. Most of the studies relied on income or income-related measures (such as prescription-drug benefits or co-payments) (27 of 32 [84%]). Meta-analysis could be quantified in 40 cohorts reported in 30 studies. Overall, the pooled adjusted risk estimate for nonadherence according to SES (high vs. low) was 0.89 (95% confidence interval 0.87-0.92; I(2) = 95%; P < 0.001). Similar patterns were observed in all subgroups examined. CONCLUSIONS Published studies have not found a strong association between low SES and nonadherence to antihypertensive medications. However, important limitations in the assessment of SES can be identified in virtually all studies. Future studies are required to ascertain whether a stronger association is observed when SES is determined by comprehensive measures.
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Affiliation(s)
- M H D Wasem Alsabbagh
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dean Eurich
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa M Lix
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas W Wilson
- Department of Medicine, Royal University Hospital, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Erin Watson
- Health Sciences Library, University of Saskatchewan, Saskatoon, SK, Canada
| | - David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
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González-Juanatey JR, Cordero A. Benefits of delapril in hypertensive patients along the cardiovascular continuum. Expert Rev Cardiovasc Ther 2014; 11:271-81. [DOI: 10.1586/erc.12.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lemstra M, Alsabbagh MW. Proportion and risk indicators of nonadherence to antihypertensive therapy: a meta-analysis. Patient Prefer Adherence 2014; 8:211-8. [PMID: 24611002 PMCID: PMC3928397 DOI: 10.2147/ppa.s55382] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The World Health Organization (WHO) concluded that poor adherence to treatment is the most important cause of uncontrolled high blood pressure, with approximately 75% of patients not achieving optimum blood pressure control. The WHO estimates that between 20% and 80% of patients receiving treatment for hypertension are adherent. As such, the first objective of our study was to quantify the proportion of nonadherence to antihypertensive therapy in real-world observational study settings. The second objective was to provide estimates of independent risk indicators associated with nonadherence to antihypertensive therapy. MATERIALS AND METHODS We performed a systematic literature review and meta-analysis of all studies published between database inception and December 31, 2011 that reviewed adherence, and risk indicators associated with nonadherence, to antihypertensive medications. RESULTS In the end, 26 studies met our inclusion and exclusion criteria and passed our methodological quality evaluation. Of the 26 studies, 48.5% (95% confidence interval 47.7%-49.2%) of patients were adherent to antihypertensive medications at 1 year of follow-up. The associations between 114 variables and nonadherence to antihypertensive medications were reviewed. After meta-analysis, nine variables were associated with nonadherence to antihypertensive medications: diuretics in comparison to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs), ACE inhibitors in comparison to ARBs, CCBs in comparison to ARBs, those with depression or using antidepressants, not having diabetes, lower income status, and minority cultural status. CONCLUSION This study clarifies the extent of adherence along with determining nine independent risk indicators associated with nonadherence to antihypertensive medications.
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Affiliation(s)
- Mark Lemstra
- Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Correspondence: Mark Lemstra, Academic Family Medicine, College of Medicine, University of Saskatchewan, 110 Science Place, Saskatoon, SK S7N 5C9, Canada, Tel +1 306 966 2108, Fax +1 306 966 6377, Email
| | - M Wasem Alsabbagh
- Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Després F, Perreault S, Lalonde L, Forget A, Kettani FZ, Blais L. Impact of drug plans on adherence to and the cost of antihypertensive medications among patients covered by a universal drug insurance program. Can J Cardiol 2013; 30:560-7. [PMID: 24613090 DOI: 10.1016/j.cjca.2013.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/18/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This study aimed to assess the impact of the type of drug plan on adherence to antihypertensive medication treatment as well as the cost of these medications within universal drug insurance programs. METHODS To compare adherence to antihypertensive medication treatment and the cost of antihypertensive medications between adults with public and private drug insurance in the province of Québec, Canada, we reconstructed a matched retrospective cohort by linking data recorded in 3 administrative databases between March 2008 and May 2010. The cohort included 186 privately and 1747 publicly insured patients aged 18-64 years who were treated with 1 or 2 antihypertensive medications. Adherence measured with the proportion of days covered (PDC) over 1 year and the cost of antihypertensive medications were evaluated for new and prevalent users separately. RESULTS More than 70% of patients were 50-64 years old and 90% of the publicly and 72% of the privately insured patients were using only 1 antihypertensive medication. The mean PDC among new users of 1 antihypertensive medication was 58.8% for privately insured patients and 65.0% for publicly insured patients, but the difference was not statistically significant. However, privately insured patients treated with 2 antihypertensive medications were more likely to be adherent (PDC-P, 15.0%; 95% confidence interval, 7.0-24.0). Privately insured patients (CAD$41.52) had to pay significantly more for their antihypertensive medications than did publicly insured patients (CAD$32.21). CONCLUSIONS The cost of antihypertensive medications was higher for patients with private drug insurance, although adherence was similar in both groups. The results may reflect regulation of dispensing fees for publicly insured patients.
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Affiliation(s)
- François Després
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada; Endowment Pharmaceutical Chair, AstraZeneca in Respiratory Health, Montreal, Québec, Canada.
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Doggrell SA, Kairuz T. Comparative studies of how living circumstances influence medication adherence in ≥65 year olds. Int J Clin Pharm 2013; 36:30-5. [PMID: 24317743 DOI: 10.1007/s11096-013-9894-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resources to help the older aged (≥65 year olds) manage their medicines should probably target those in greatest need. The older-aged have many different types of living circumstances. There are different locations (urban, rural), different types of housing (in the community or in retirement villages), different living arrangements (living alone or with others), and different socioeconomic status (SES) circumstances. However, there has been limited attention to whether these living circumstances affect adherence to medicines in the ≥65 year olds. AIM OF THE REVIEW The aim was to determine whether comparative studies, including logistic regression studies, show that living circumstances affect adherence to medicines by the ≥65 year olds. METHODS A literature search of Medline, CINAHL and the Internet (Google) was undertaken. RESULTS Four comparative studies have not shown differences in adherence to medicines between the ≥65 year olds living in rural and urban locations, but one study shows lower adherence to medicines for osteoporosis in rural areas compared to metropolitan, and another study shows greater adherence to antihypertensive medicines in rural than urban areas. There are no comparative studies of adherence to medicines in the older-aged living in indigenous communities compared to other communities. There is conflicting evidence as to whether living alone, being unmarried, or having a low income/worth is associated with nonadherence. Preliminary studies have suggested that the older-aged living in rental, low SES retirement villages or leasehold, middle SES retirement villages have a lower adherence to medicines than those living in freehold, high SES retirement villages. CONCLUSIONS The ≥65 year olds living in rural communities may need extra help with adherence to medicines for osteoporosis. The ≥65 year olds living in rental or leasehold retirement villages may require extra assistance/resources to adhere to their medicines. Further research is needed to clarify whether living under certain living circumstances (e.g. living alone, being unmarried, low income) has an effect on adherence, and to determine whether the ≥65 year olds living in indigenous communities need assistance to be adherent to prescribed medicines.
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Affiliation(s)
- Sheila A Doggrell
- Faculty of Health, Gardens Point, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4001, Australia,
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Mozheyko M, Eregin S, Vigdorchik A, Tobe S, Campbell N, Riahi F, Hughes D. Changes in hypertension treatment in the yaroslavl region of Russia: improvements observed between 2 cross-sectional surveys. J Clin Hypertens (Greenwich) 2013; 15:918-24. [PMID: 24118731 PMCID: PMC4255293 DOI: 10.1111/jch.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/21/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022]
Abstract
This prospective before-and-after survey of hypertensive patients visiting government-run outpatient health facilities in the Yaroslavl Region of Russia assessed blood pressure (BP)-related endpoints following initiation of a comprehensive health system improvement program for hypertension. Two cross-sectional surveys, one at baseline and the other approximately 1 year after program initiation, evaluated the primary measure of BP control rate. Secondary measures included mean BP levels and distribution, cardiovascular risk factors, and associated conditions, heart rate levels, and antihypertensive therapy. From the 2011 survey (n=1794) to the 2012 survey (n=2992), BP control rate (<140/90 mm Hg) significantly increased from 16.8% to 23.0%, reflecting a 37% relative improvement (P<.0001). Mean BP level was significantly reduced from 151/90 mm Hg to 147/88 mm Hg (P<.0001). Severe uncontrolled hypertension (systolic BP ≥180 mm Hg) was reduced from 9.7% to 6.4% (P<.0001). Implementing a guidelines-based treatment protocol with medical and patient education programs resulted in physician behavior change and improved patient BP control.
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Affiliation(s)
- Maria Mozheyko
- Department of CardiologyYaroslavl Regional Clinical Hospital of War VeteransYaroslavlRussia
| | - Sergey Eregin
- Cardiology CenterYaroslavl Regional Clinical HospitalYaroslavlRussia
| | | | - Sheldon Tobe
- Sunnybrook Health Sciences CentreTorontoONCanada
| | - Norman Campbell
- Community Health Sciences and Physiology and PharmacologyLibin Cardiovascular Institute of AlbertaABCanada
| | - Farhad Riahi
- Healthcare SystemsNovartis International AGBaselSwitzerland
| | - David Hughes
- Healthcare SystemsNovartis International AGBaselSwitzerland
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Midy F, Rudnichi A. The impact of cardiovascular profile on persistence associated with antihypertensive medications. Int J Clin Pract 2013; 67:1334-41. [PMID: 24246212 DOI: 10.1111/ijcp.12253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 07/16/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antihypertensive drug treatment (AHT) is effective in reducing the risks of cardiovascular events, but long-term persistence is required to achieve these benefits. The aim of the present study was to evaluate persistence with antihypertensive treatment in France. METHODS AND RESULTS A total of 6924 patients, first prescribed for hypertension in 2008, were retrospectively studied from the principal French National Public Health Insurance Scheme database. Persistence was defined as remaining on therapy at the end of the 12 months postindex date. Cox proportional hazards regression models controlled for demographics and cardiovascular profile. Over 1 year, 65% of patients were persistent and 16% maintained the initial therapy. When correcting for significant factors determining persistence, a 13% risk reduction of discontinuation is observed with angiotensin II antagonists (AIIAs) and 11% with angiotensin-converting enzymes inhibitors (ACE) compared with thiazide diuretics. Persistence therapy depended significantly on the cardiovascular profile. In the secondary prevention subgroup (18% of the study population), no statistically significant differences were observed between thiazide diuretics and the four major classes. In contrast, a 19% risk reduction of discontinuation is observed with AIIA and with ACE compared with thiazide diuretics for primary prevention patients without diabetes or hyperlipidaemia. CONCLUSIONS When choosing AHT agents for patients with essential hypertension, practitioners are primarily driven by the cardiovascular profile of patients. The study suggests that the therapeutic decision must encompass the individual 'persistence risk', the latter not being independent from the cardiovascular risk.
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Affiliation(s)
- F Midy
- SEESP (Service de l'évaluation économique et de la santé publique), Haute Autorité de Santé, Saint Denis La Plaine, France
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Wong MC, Tam WW, Cheung CS, Tong EL, Sek AC, Cheung N, Leeder S, Griffiths S. Medication adherence to first-line antihypertensive drug class in a large Chinese population. Int J Cardiol 2013; 167:1438-42. [PMID: 22560948 PMCID: PMC7132368 DOI: 10.1016/j.ijcard.2012.04.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/15/2012] [Accepted: 04/08/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Suboptimal adherence to antihypertensive agents leads to adverse clinical outcomes. This study aims to evaluate the association between first-line antihypertensive drug class and medication adherence in a large Chinese population. METHODS All patients prescribed ≥ one antihypertensive drug in 2001-2003 and 2005 who have paid at least two consecutive clinic visits in the public healthcare system of Hong Kong were included. We excluded patients who have followed-up in the clinics for ≤ 30 days. Interval-based Proportion of Days Covered (PDC) was used to assess medication adherence. All patients were followed-up for up to 5 years. Binary logistic regression analysis was used to evaluate the factors associated with optimal adherence, defined as PDC ≥ 80%. RESULTS From 147,914 eligible patients, 69.2% were adherent to the antihypertensive prescriptions. When compared with angiotensin converting enzyme inhibitors (ACEIs), patients initially prescribed α-blockers (adjusted odds ratio [AOR]=0.234, 95% C.I. 0.215-0.256), β-blockers (AOR=0.447, 95% C.I. 0.420, 0.477), thiazide diuretics (AOR=0.431 95% C.I. 0.399, 0.466) and calcium channel blockers (AOR=0.451, 95% C.I. 0.423, 0.481) were significantly less likely to be drug adherers. Angiotensin receptor blockers (ARBs) and fixed-dose combination therapies were similarly likely to be medication adherent. Older age, male gender, visits in general out-patient clinics, residence in urbanized regions, and the presence of comorbidity were positively associated with optimal drug adherence. CONCLUSION Patients receiving initial prescriptions of ACEIs, ARB and combination therapy had more favorable adherence profiles than the other major antihypertensive classes in real-life clinical practice.
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Affiliation(s)
- Martin C.S. Wong
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Wilson W.S. Tam
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Clement S.K. Cheung
- Hospital Authority Information Technology Services – Health Informatics Section, Hong Kong
| | - Ellen L.H. Tong
- Hospital Authority Information Technology Services – Health Informatics Section, Hong Kong
| | - Antonio C.H. Sek
- Hospital Authority Information Technology Services – Health Informatics Section, Hong Kong
| | - N.T. Cheung
- Hospital Authority Information Technology Services – Health Informatics Section, Hong Kong
| | - Stephen Leeder
- Menzies Centre for Health Policy, University of Sydney, Australia
| | - Sian Griffiths
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
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Lapi F, Lucenteforte E, Moschini M, Bonaiuti R, Di Pirro M, Barchielli A, Benemei S, Belladonna M, Nesti N, Coppini R, Taras M, Vannacci A, Ungar A, Mugelli A. Representativeness of the "Fiesole Misurata" study database for use in pharmaco-epidemiological investigations on adherence to antihypertensive medications. Aging Clin Exp Res 2013; 25:433-45. [PMID: 23780690 DOI: 10.1007/s40520-013-0060-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 03/04/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Poor adherence to medications is a major health concern especially among older subjects. To plan future studies to improve adherence, an epidemiological study, called "Fiesole Misurata", was conducted. The aim of the present paper was to verify the representativeness of the database in evaluating the AntiHyperTensives (AHTs)-taking behaviour. METHODS Demographic records of all subjects aged ≥65 years (n = 2,228) living in the community of Fiesole (Florence, Italy) was retrieved from the Registry Office of Fiesole Municipality. The corresponding healthcare records were obtained from administrative archives of the Local Health Authority (claim dataset). Moreover, a cohort of subjects aged ≥65 years (n = 385) living in the community was screened by means of a multidimensional geriatric evaluation (cross-sectional dataset). RESULTS In claim dataset, biyearly prevalences of hospitalization for ischemic cardiomyopathy, heart failure, and stroke were 3.7, 3.0, and 3.2%, respectively. In the cross-sectional dataset, prevalences were 11.2, 6.7, and 7.1%, respectively. The most used drugs were angiotensin-converting enzyme inhibitors (43.6% in the claim dataset, 45.3% in the cross-sectional dataset) and diuretics (35.6% and 47.0%, respectively). Among the incident users of AHTs, 63.5% was highly adherent (≥80%) over the first 6 months of follow-up, while 14.3 and 22.2% were intermediate (40-79%) and low (<40%) adherent. The percentage of high adherers decreased with time and reached 31.2% at the 24th month. CONCLUSIONS These findings indicate that "Fiesole Misurata" study database can be used to develop future strategies aimed at improving the adherence to AHTs in older individuals.
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Affiliation(s)
- Francesco Lapi
- Department of Preclinical and Clinical Pharmacology, Centre for Molecular Medicine (CIMMBA), University of Florence, viale G. Pieraccini 6, 50139, Florence, Italy
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Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Bengtsson Boström K, Manhem K, Hjerpe P, Wettermark B. Persistence to antihypertensive drug treatment in Swedish primary healthcare. Eur J Clin Pharmacol 2013; 69:1955-64. [DOI: 10.1007/s00228-013-1555-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/26/2013] [Indexed: 12/24/2022]
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Lee GKY, Wang HHX, Liu KQL, Cheung Y, Morisky DE, Wong MCS. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky Medication Adherence Scale. PLoS One 2013; 8:e62775. [PMID: 23638143 PMCID: PMC3636185 DOI: 10.1371/journal.pone.0062775] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 03/26/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients. METHODS A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points). RESULTS From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence. CONCLUSION This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.
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Affiliation(s)
- Gabrielle K. Y. Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry H. X. Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kirin Q. L. Liu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Cheung
- New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Donald E. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, United States of America
| | - Martin C. S. Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Difficulty adhering to antidiabetic treatment: factors associated with persistence and compliance. DIABETES & METABOLISM 2013; 39:250-7. [PMID: 23523643 DOI: 10.1016/j.diabet.2012.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 01/24/2023]
Abstract
AIMS This study aimed to assess the 1-year treatment persistence and compliance of new oral antidiabetic drug (OAD) users with their treatment, and to identify the factors associated with both persistence and compliance. METHODS This population-based cohort study of new OAD users aged 18 years or above used the Quebec health insurance board databases. Those having a prescription filled for antidiabetic treatment during the period leading up to the 1-year anniversary of their first claim were considered to be persistent with their antidiabetic treatment. Of these patients, individuals with a medication possession ratio (MPR) greater or equal to 80% for OAD or insulin were deemed compliant. Also identified were the characteristics associated with both outcomes, using a multivariate logistic regression model. RESULTS Our cohort consisted of 151,173 individuals, 119,832 (79.3%) of whom were considered persistent. Of these, 93,418 (78.0%) were also deemed compliant. Persistence and compliance were associated with older ages, living in a rural region, low socioeconomic status, having the first OAD prescribed by a general practitioner and a history of using five different drugs or more. People were less likely to be persistent and compliant if their initial OAD was a secretagogue and if they had consulted a physician eight times or more during the year prior to starting treatment. CONCLUSION One year after OAD treatment initiation, 21% had discontinued their treatment and 22% of those still being treated were non-compliant. These results could help to tailor interventions aimed at optimizing the use of OAD treatments.
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Evans CD, Eurich DT, Lu X, Remillard AJ, Shevchuk YM, Blackburn D. The association between market availability and adherence to antihypertensive medications: an observational study. Am J Hypertens 2013; 26:180-90. [PMID: 23382402 DOI: 10.1093/ajh/hps017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reported in observational studies has frequently been attributed to improved tolerability. However, these agents are also relatively new to the market compared to other antihypertensive medications. We aimed to determine if an association exists between adherence and market availability of a specific antihypertensive agent. METHODS This retrospective cohort study used administrative data from Saskatchewan, Canada. Subjects were ≥40 years of age and received a new antihypertensive medication between 1994 and 2002. The primary outcome was the proportion of subjects achieving optimal adherence (≥80%) at 1 year, stratified by antihypertensive medication class and the year of availability. Adherence was measured using the cumulative mean gap ratio. RESULTS A total of 36,214 subjects met the inclusion criteria. Optimal adherence was observed in 4987 of 8623 (57.8%) subjects receiving ACEIs and 1013 of 1600 (63.3%) subjects receiving ARBs, but adherence appeared inconsistent when examined within each antihypertensive class. A pattern of increasing mean adherence was observed according to availability in the ACEI subgroup (Spearman r = 0.82; P = 0.007) but not the ARB subgroup (Spearman r = 0.41; P = 0.49). However, the association between availability and optimal adherence converged when ARB and ACEI users were combined (Spearman r = 0.85, P < 0.001). CONCLUSIONS Optimal adherence with ACEIs and ARBs compared to other antihypertensive agents may be associated with their relative availability. To what extent optimal adherence is also associated with improved tolerability, as currently believed, remains to be determined.
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Affiliation(s)
- Charity D Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Marcum ZA, Zheng Y, Perera S, Strotmeyer E, Newman AB, Simonsick EM, Shorr RI, Bauer DC, Donohue JM, Hanlon JT. Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Res Social Adm Pharm 2013; 9:817-27. [PMID: 23291338 DOI: 10.1016/j.sapharm.2012.12.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Information about the prevalence and correlates of self-reported medication nonadherence using multiple measures in older adults with chronic cardiovascular conditions is needed. OBJECTIVE To examine the prevalence and correlates of self-reported medication nonadherence among community-dwelling elders with chronic cardiovascular conditions. METHODS Participants (n = 897) included members from the Health, Aging and Body Composition Study with coronary heart disease, diabetes mellitus, and/or hypertension at Year 10. Self-reported nonadherence was measured by the 4-item Morisky Medication Adherence Scale (MMAS-4) and 2-item cost-related nonadherence (CRN-2) scale at Year 11. Factors (demographic, health status, and access to care) were examined for association with the MMAS-4 and then for association with the CRN-2 scale. RESULTS Nonadherence per the MMAS-4 and CRN-2 scale was reported by 40.7% and 7.7% of participants, respectively, with little overlap (3.7%). Multivariable logistic regression analyses found that black race was significantly associated with nonadherence per the MMAS-4 (P = 0.002) and the CRN-2 scale (P = 0.005). Other correlates of nonadherence per the MMAS-4 (with independent associations) included having cancer (P = 0.04), a history of falls (P = 0.02), sleep disturbances (P = 0.04) and having a hospitalization in the previous 6 months (P = 0.005). Conversely, being unmarried (P = 0.049), having worse self-reported health (P = 0.04) and needs being poorly met by income (P = 0.02) showed significant independent associations with nonadherence per the CRN-2 scale. CONCLUSIONS Self-reported medication nonadherence was common in older adults with chronic cardiovascular conditions and only one factor - race - was associated with both types. The research implication of this finding is that it highlights the need to measure both types of self-reported nonadherence in older adults. Moreover, the administration of these quick measures in the clinical setting should help identify specific actions such as patient education or greater use of generic medications or pill boxes that may address barriers to medication nonadherence.
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Affiliation(s)
- Zachary A Marcum
- Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Campbell NRC, McAlister FA, Quan H. Monitoring and evaluating efforts to control hypertension in Canada: why, how, and what it tells us needs to be done about current care gaps. Can J Cardiol 2012; 29:564-70. [PMID: 22809887 DOI: 10.1016/j.cjca.2012.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022] Open
Abstract
Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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