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Pietrzykowski Ł, Kasprzak M, Michalski P, Kosobucka A, Fabiszak T, Kubica A. Therapy Discontinuation after Myocardial Infarction. J Clin Med 2020; 9:E4109. [PMID: 33352811 PMCID: PMC7766090 DOI: 10.3390/jcm9124109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. MATERIAL AND METHODS The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. RESULTS Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42-18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45-16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)-1.59; 95% CI 1.15-2.19; p = 0.0049) and prior revascularization (HR-1.44; 95% CI 1.04-2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. CONCLUSIONS The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
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Affiliation(s)
- Łukasz Pietrzykowski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Michał Kasprzak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Piotr Michalski
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Agata Kosobucka
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
| | - Tomasz Fabiszak
- Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (M.K.); (T.F.)
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland; (P.M.); (A.K.); (A.K.)
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Shin J, Chia Y, Heo R, Kario K, Turana Y, Chen C, Hoshide S, Fujiwara T, Nagai M, Siddique S, Sison J, Tay JC, Wang T, Park S, Sogunuru GP, Minh HV, Li Y. Current status of adherence interventions in hypertension management in Asian countries: A report from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2020; 23:584-594. [PMID: 33350024 PMCID: PMC8029547 DOI: 10.1111/jch.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
Adherence continues to be the major hurdle in hypertension management. Since the early 2000s, systematic approaches have been emphasized to tackle multi-dimensional issues specific for each regional setting. However, there is little data regarding implementation of adherence interventions in Asian countries. Eleven hypertension experts from eight Asian countries answered questionnaires regarding the use of adherence interventions according to 11 theoretical domain frameworks by Allemann et al. A four-point Likert scale: Often, Sometimes, Seldom, and Never used was administered. Responses to 97 items from 11 domains excluding three irrelevant items were collected. "Often-used" interventions accounted for 5/9 for education, 1/8 for skills, 1/2 for social/professional role and identity, 1/1 for belief about capabilities, 0/3 for belief about consequences, 2/4 for intentions, 2/9 for memory, attention, and decision process, 11/20 for environmental context and resources, 0/2 for social influences, 0/2 for emotion, and 2/2 for behavioral regulation. Most of them are dependent on conventional resources. Most of "Never used" intervention were the adherence interventions related to multidisciplinary subspecialties or formal training for behavioral therapy. For adherence interventions recommended by 2018 ESC/ESH hypertension guidelines, only 1 in 7 patient level interventions was "Often used." In conclusion, conventional or physician level interventions such as education, counseling, and prescription have been well implemented but multidisciplinary interventions and patient or health system level interventions are in need of better implementation in Asian countries.
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Affiliation(s)
- Jinho Shin
- Division of CardiologyDepartment of Internal MedicineHanyang University Medical CenterSeoulSouth Korea
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Ran Heo
- Division of CardiologyDepartment of Internal MedicineHanyang University Medical CenterSeoulSouth Korea
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Chen‐Huan Chen
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takeshi Fujiwara
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Michiaki Nagai
- Department of Internal Medicine, General Medicine and CardiologyHiroshima City Asa HospitalHiroshimaJapan
| | | | - Jorge Sison
- Cardiology SectionDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Tzung‐Dau Wang
- Department of Internal MedicineNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Sungha Park
- Division of Cardiology SeoulCardiovascular HospitalYonsei Health SystemSeoulSouth Korea
| | - Guru Prasad Sogunuru
- MIOT International Hospital ChennaiChennaiIndia
- College of Medical Sciences BharatpurKathmandu UniversityDhulikhelNepal
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | - Yan Li
- Department of HypertensionThe Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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Medication adherence and its determinants in patients after myocardial infarction. Sci Rep 2020; 10:12028. [PMID: 32694522 PMCID: PMC7374107 DOI: 10.1038/s41598-020-68915-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Non-adherence to prescribed medication is a serious limitation of long-term treatment in patients after myocardial infarction (MI), which can be associated with medical, social and economical consequences. Improvement of medication adherence has been shown to be a challenge for healthcare providers. The aim of this study was to evaluate changes in medication adherence and variability of adherence determinants during follow-up in patients after MI. A single-center, cohort observational study was conducted in 225 post-MI patients treated with primary coronary intervention (PCI) (27% women and 73% men) aged 30–91 years. Adherence was defined as availability of evaluated drugs within 1-year after discharge from hospital, based on completed prescriptions data obtained from the National Health Fund. The analysis of therapeutic plan realization (adherence to medication prescribed at discharge from hospital) embraced only reimbursed drugs: ACEIs (ramipril, perindopril), P2Y12 receptor inhibitors (clopidogrel) and statins (atorvastatin, simvastatin, rosuvastatin). Sufficient adherence was defined as ≥ 80%. During 1-year follow-up, adherence for all three drug classes was 64 ± 25%, with 67 ± 32% for ACEIs, 62 ± 34% for P2Y12 receptor inhibitor and 64 ± 32% for statins. A gradual decline in adherence was observed from 65% ± 26% in the first quarter of follow-up to 51% ± 34% in the last quarter of follow-up (p < 0.00001). Sufficient adherence for all drugs classes was found only in 29% of patients throughout the whole follow-up period (44% for ACEI, 36% for P2Y12 receptor inhibitor and 41% for statins). According to a multivariate analysis, age, prior CABG, level of education, place of residence, economic status and marital status were independent predictors of drug adherence. Whereas patients > 65 years and having a history of prior CABG more often had an insufficient adherence to drugs, married and hypertensive patients, city inhabitants and patients with higher education tended to have a sufficient drug adherence. Adherence to pharmacotherapy after myocardial infarction decreases over time in a similar manner for all pivotal groups of drugs prescribed after MI. A number of socioeconomic and clinical factors have been identified to affect medication adherence over time.
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Cui B, Dong Z, Zhao M, Li S, Xiao H, Liu Z, Yan X. Analysis of Adherence to Antihypertensive Drugs in Chinese Patients with Hypertension: A Retrospective Analysis Using the China Health Insurance Association Database. Patient Prefer Adherence 2020; 14:1195-1204. [PMID: 32764892 PMCID: PMC7373416 DOI: 10.2147/ppa.s243665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the adherence to antihypertensive drugs in Chinese patients with hypertension and the factors associated with the drug adherence. METHODS The data for this analysis were obtained from the 2014 China Health Insurance Association (CHIRA) database. The study included 64,576 patients aged ≥18 years who were prescribed one of the seven antihypertensive drugs included in the study in their first prescription in 2014 and were observed for ≥180 days. The medicine possession ratio (MPR) was calculated and taken as the measure of treatment adherence. MPR values <0.3, 0.3 to <0.5, 0.5 to <0.8, and ≥0.8 were considered treatment adherence very low, low, intermediate, and high, respectively. Descriptive statistics were used to present baseline data and treatment adherence rate. Multiple regression models were used to determine independent factors which can affect the treatment adherence rate. P-value <0.05 was considered significant. RESULTS Among the study antihypertensive drugs, amlodipine (33.98%), metoprolol (25.04%), and nifedipine (17.15%) were the frequently prescribed drugs. Nifedipine controlled release tablet had the highest MPR (0.61), followed by valsartan (0.53), valsartan/amlodipine fixed-dose combination (0.50), indapamide (0.40), and amlodipine (0.39), whereas benazepril (0.27) and metoprolol (0.19) had the lowest MPR. Higher reimbursement ratio, regular tertiary hospitals visits, lower age, and lower daily medical cost positively affected treatment adherence, whereas longer duration of illness and higher daily average cost affected treatment adherence negatively. CONCLUSION Our study assessed that prescribing more cost-effective, long-acting antihypertensive drugs, and raising the reimbursement ratio were associated with a better treatment adherence in Chinese patients with hypertension.
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Affiliation(s)
- Bin Cui
- School of Public Health, Peking University, Beijing100191, People’s Republic of China
| | - Zhaohui Dong
- Human Resources and Social Security, Chinese Academy of Labour and Social Security, Beijing, 100029, People’s Republic of China
| | - Mengmeng Zhao
- School of Pharmaceutical Science and Technology, School of Pharmacy, Tianjin University, Tianjin, 300072, People’s Republic of China
| | - Shanshan Li
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Hua Xiao
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Zhitao Liu
- Medical Affairs, Bayer Healthcare Company Limited (China), Beijing, 100020, People’s Republic of China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China
- Correspondence: Xiaowei Yan Peking Union Medical College Hospital, Beijing100730, People’s Republic of China Email
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Chen S, Conwell Y, Xue J, Li LW, Tang W, Bogner HR, Dong H. Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study. BMC Geriatr 2018; 18:124. [PMID: 29843644 PMCID: PMC5975464 DOI: 10.1186/s12877-018-0808-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 01/05/2023] Open
Abstract
Background Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. Methods The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person’s primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village’s Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects’ electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. Discussion The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. Trial registration ClinicalTrials.gov ID: NCT01938963; First posted: September 10, 2013.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, USA.
| | - Jiang Xue
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Lydia W Li
- School of Social Work, University of Michigan, Ann Arbor, USA
| | - Wan Tang
- Department of Global Biostatistics and Data Science, Tulane University, New Orleans, USA
| | - Hillary R Bogner
- Department of Family Medicine, University of Pennsylvania, Philadelphia, USA
| | - Hengjin Dong
- Faculty of Public Health Research, Zhejiang University, Hangzhou, China
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Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e5641. [PMID: 28121920 PMCID: PMC5287944 DOI: 10.1097/md.0000000000005641] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases. OBJECTIVE This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients. METHODS Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects. RESULTS A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%). CONCLUSION Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.
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Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Abdulla Shehab
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Asim Ahmed Elnour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Fathima College of Health Sciences, Al Ain, UAE
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Wong MC, Tam WW, Wang HH, Cheung CS, Tong EL, Cheung N, Leeder SR, Griffiths SM. Duration of initial antihypertensive prescription and medication adherence: A cohort study among 203,259 newly diagnosed hypertensive patients. Int J Cardiol 2015; 182:503-8. [DOI: 10.1016/j.ijcard.2014.12.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/25/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
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Yue Z, Bin W, Weilin Q, Aifang Y. Effect of medication adherence on blood pressure control and risk factors for antihypertensive medication adherence. J Eval Clin Pract 2015; 21:166-72. [PMID: 25318567 DOI: 10.1111/jep.12268] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 12/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES We aim to investigate a range of risk factors associated with medication adherence among Chinese hypertensive patients. We also aim to investigate the association between medication adherence and blood pressure control. METHODS A cross-sectional study was conducted among Chinese hypertensive patients in a comprehensive teaching hospital in Shanghai, China, using a validated scale, a self-designed questionnaire and patients' medical records. RESULTS Of the 232 eligible participants, 61 (26.3%), 51 (22.0%) and 120 (51.7%) showed low, medium and high adherence, respectively. Adjusted for socio-demographic, clinical and patient-related factors, antihypertensive medication adherence was significantly associated with better systolic blood pressure control (P=0.001), whereas the association with diastolic blood pressure control was relatively weak (P=0.334). In the multivariate analysis, patients with longer duration of drug use [P=0.012, odds ratio (OR)=0.46, 95% confidence interval (CI) 0.25-0.84], combination of antiplatelet agents (0.002, 0.38, 0.20-0.71), less concerns of medical cost (0.001, 0.18, 0.02-0.51), more availability of professional guidance (0.002, 0.34, 0.17-0.66) and more availability of family support (0.036, 0.51, 0.27-0.96) were more likely to adhere to their drug regimens. CONCLUSIONS The rate of suboptimal medication adherence among Chinese hypertensive patients is quite high. Interventions could focus upon the risk factors to improve antihypertensive medication adherence in clinical practice.
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Affiliation(s)
- Zhao Yue
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
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Wong MCS, Wu CHM, Wang HHX, Li HW, Hui EMT, Lam AT, Chung RYN, Yip BHK, Morisky DE. Association between the 8-item Morisky medication adherence scale (MMAS-8) score and glycaemic control among Chinese diabetes patients. J Clin Pharmacol 2014; 55:279-87. [PMID: 25293349 DOI: 10.1002/jcph.408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/11/2022]
Abstract
Adherence with oral hypoglycaemic agent is crucial to achieve optimal glycaemic control. The 8-item Morisky Medication Adherence Scale (MMAS-8) has been frequently used, yet the association between MMAS-8 score and glycaemic control among Chinese diabetes patients is largely unknown. Two general out-patient clinics were randomly selected in a district with socio-demographic characteristics representative of the entire Hong Kong population. A consecutive sample of adult type-2 diabetes patients currently taking oral hypoglycaemic agents was included. The glycaemic control was reflected by the level of hemoglobin A1c (HbA1c) taken within the previous 6 months. Factors associated with poor glycaemic control (HbA1c ≥ 7.0%) were evaluated by linear regression analysis. From 565 eligible Chinese patients with an average age of 63.2 years (SD 9.7) and male proportion of 46.5%, the average HbA1c was 7.1% (SD 1.1%), and 52.0% had poor glycaemic control. The proportion of poor medication adherence (MMAS-8 ≤ 6) was 32.2%. After controlling for socio-demographics, lifestyle, medication use, and health characteristics, the MMAS-8 score was correlated with better glycaemic control (beta -0.095; 95%CI -0.164 to -0.026, P = .007). The MMAS-8 score had a weak and negative correlation with HbA1c level. The instrument should be applied with caution when predicting glycaemic control in clinical practice.
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Affiliation(s)
- Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Carmen H M Wu
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Harry H X Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Heung Wing Li
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Eric M T Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Augustine T Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Roger Y N Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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The incidence of cancer deaths among hypertensive patients in a large Chinese population: a cohort study. Int J Cardiol 2014; 179:178-85. [PMID: 25464439 DOI: 10.1016/j.ijcard.2014.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/04/2014] [Accepted: 10/14/2014] [Indexed: 11/23/2022]
Abstract
Current evidence is mixed regarding the association between antihypertensive prescriptions and cancer mortality. We evaluated this association in a large Chinese hypertensive population. We followed for five years all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 in a public healthcare sector of Hong Kong. The association between antihypertensive drug class and cancer mortality was evaluated by Cox proportional hazard models with propensity score matching. Age, gender, socioeconomic status, service settings, district of residence, proportion of days covered reflecting medication adherence, and the number of comorbidities were adjusted. From 217,910 eligible patients, 9500 (4.4%) died from cancer within five years after their first-ever antihypertensive prescription. Most cancer deaths occurred in the digestive (38.9%) and respiratory system (30.4%); the breast (6.2%); and the lympho-hematopoietic tissues (5.3%). The proportion of patients who died from cancer was the highest in the calcium channel blocker (CCB) group (6.5%), followed by thiazide diuretics (4.4%), angiotensin converting enzyme inhibitors (4.2%) and β-blockers (2.6%). When compared with β-blockers, patients prescribed CCBs (Adjusted Hazard Ratio [AHR]=1.406, 95% C.I. 1.334-1.482, p<0.001) were more likely to die from cancer. Thiazide users were also more likely to suffer from cancer deaths (AHR=1.364, 95% C.I. 1.255-1.483, p<0.001), but became insignificant in stratified analysis. The association between cancer mortality and use of CCB, and perhaps thaizide, may alert physicians to the need for more meticulous and comprehensive care of these patients in clinical practice. We recommend prospective studies to evaluate cause-and-effect relationships of these associations.
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Wong MCS, Wang HHX, Cheung CSK, Tong ELH, Sek ACH, Cheung NT, Yan BPY, Yu CM, Griffiths SM, Coats AJS. Factors associated with multimorbidity and its link with poor blood pressure control among 223,286 hypertensive patients. Int J Cardiol 2014; 177:202-8. [PMID: 25499379 DOI: 10.1016/j.ijcard.2014.09.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/17/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022]
Abstract
Multimorbidity has become the norm worldwide as populations age. It remains, however, infrequently researched. This study evaluated factors associated with multimorbidity in a predominantly Chinese hypertensive population. We included all adult patients prescribed their first antihypertensive agents in the entire public sector in Hong Kong from a validated database. Multimorbidity was defined as having one or more medical conditions (cardiovascular diseases; respiratory diseases; diabetes or impaired fasting glucose; renal disease) in addition to hypertension. We studied the prevalence of multimorbidity and performed multinomial regression analyses to evaluate factors independently associated with multimorbidity. 223,286 hypertensive patients (average age of 59.9 years, SD 17.6) were included. The prevalence of having 0, 1 and ≥ 2 additional conditions was 59.6%, 32.8% and 7.5%, respectively. The most common conditions were cardiovascular disease (24.2%) and diabetes (23.0%), followed by respiratory disorders (14.6%) and renal disease (10.9%). Older age (>50 years), male sex, lower household income, receipt of social security allowance and suboptimal blood pressure control (>140 mmHg or >90 mmHg; >130 mmHg or >80 mmHg for diabetes patients; AOR = 3.38-4.49) were significantly associated with multimorbidity. There exists a synergistic effect among these variables as older (≥ 70 years), male patients receiving security allowance had substantially higher prevalence of multimorbidity (19.9% vs 7.5% among all patients). Multimorbidity is very common in hypertensive patients and its prevalence increased markedly with the presence of risk factors identified in this study. Hypertensive patients with multimorbidities should receive more meticulous clinical care as their blood pressure control tends to be poorer.
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Affiliation(s)
- Martin C S Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., Hong Kong.
| | - Harry H X Wang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., 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
| | - Bryan P Y Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., Hong Kong
| | - Cheuk-Man Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., Hong Kong
| | - Sian M Griffiths
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., Hong Kong
| | - Andrew J S Coats
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT., Hong Kong; Monash University, Australia, University of Warwick, Coventry, UK
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Wong MCS, Tam WWS, Wang HHX, Lao XQ, Zhang DD, Chan SWM, Kwan MWM, Fan CKM, Cheung CSK, Tong ELH, Cheung NT, Tse LA, Yu ITS. Exposure to air pollutants and mortality in hypertensive patients according to demography: a 10 year case-crossover study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2014; 192:179-185. [PMID: 24953346 DOI: 10.1016/j.envpol.2014.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/28/2014] [Indexed: 06/03/2023]
Abstract
This study evaluated whether short term exposures to NO2, O3, particulate matter <10 mm in diameter (PM10) were associated with higher risk of mortality. A total of 223,287 hypertensive patients attended public health-care services and newly prescribed at least 1 antihypertensive agent were followed-up for up to 5 years. A time-stratified, bi-directional case-crossover design was adopted. For all-cause mortality, significant positive associations were observed for NO2 and PM10 at lag 0-3 days per 10 μg/m(3) increase in concentration (excess risks 1.187%-2.501%). Significant positive associations were found for O3 at lag 1 and 2 days and the excess risks were 1.654% and 1.207%, respectively. We found similarly positive associations between these pollutants and respiratory disease mortality. These results were significant among those aged ≥65 years and in cold seasons only. Older hypertensive patients are susceptible to all-cause and respiratory disease-specific deaths from these air pollutants in cold weather.
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Affiliation(s)
- Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Wilson W S Tam
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Harry H X Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - X Q Lao
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Daisy Dexing Zhang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Sky W M Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Mandy W M Kwan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Carmen K M Fan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Clement S K Cheung
- Hospital Authority Information Technology Division - Health Informatics Section, Hong Kong, China
| | - Ellen L H Tong
- Hospital Authority Information Technology Division - Health Informatics Section, Hong Kong, China
| | - N T Cheung
- Hospital Authority Information Technology Division - Health Informatics Section, Hong Kong, China
| | - L A Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Ignatius T S Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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13
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Tsoi KKF, Wong MCS, Tam WWS, Hirai HW, Lao XQ, Wang HHX, Kwan MWM, Cheung CSK, Tong ELH, Cheung NT, Yan BP, Meng HML, Griffiths SM. Cardiovascular mortality in hypertensive patients newly prescribed perindopril vs. lisinopril: a 5-year cohort study of 15,622 Chinese subjects. Int J Cardiol 2014; 176:703-9. [PMID: 25131919 DOI: 10.1016/j.ijcard.2014.07.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/24/2014] [Accepted: 07/26/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Perindopril and lisinopril are two common ACE inhibitors prescribed for management of hypertension. Few studies have evaluated their comparative effectiveness to reduce mortality. This study compared the all-cause and cardiovascular related mortality among patients newly prescribed ACE inhibitors. METHODS All adult patients newly prescribed perindopril or lisinopril from 2001 to 2005 in all public clinics or hospitals in Hong Kong were retrospectively evaluated, and followed up until 2010. Patients prescribed the ACE inhibitors for less than a month were excluded. The all-cause mortality and cardiovascular-specific (i.e. coronary heart disease, heart failure and stroke) mortality were compared. Cox proportional hazard regression model was used to assess the mortality, controlling for age, sex, socioeconomic status, patient types, the presence of comorbidities, and medication adherence as measured by the proportion of days covered. An additional model using propensity scores was performed to minimize indication bias. RESULTS A total of 15,622 patients were included in this study, in which 6910 were perindopril users and 8712 lisinopril users. The all-cause mortality (22.2% vs. 20.0%, p<0.005) and cardiovascular mortality (6.5% vs. 5.6%, p<0.005) were higher among lisinopril users than perindopril users. From regression analyses, lisinopril users were 1.09-fold (95% C.I. 1.01-1.16) and 1.18-fold (95% C.I. 1.02-1.35) more likely to die from any-cause and cardiovascular diseases, respectively. Age-stratified analysis showed that this significant difference was observed only among patients aged >70 years. The additional models controlled for propensity scores yielded comparable results. CONCLUSIONS The long-term all-cause and cardiovascular related mortality rates of lisinopril users was significantly different from those of perindopril users. These findings showed that intra-class variation on mortality exists among ACE inhibitors among those aged 70 years or older. Future studies should consider a longer, large-scale randomized controlled trial to compare the effectiveness between different medications in the ACEI class, especially among the elderly.
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Affiliation(s)
- Kelvin K F Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Wilson W S Tam
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Hoyee W Hirai
- Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, China
| | - X Q Lao
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Harry H X Wang
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Mandy W M Kwan
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | | | - Ellen L H Tong
- Health Informatics Section, Hospital Authority, Hong Kong, China
| | - N T Cheung
- Health Informatics Section, Hospital Authority, Hong Kong, China
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Helen M L Meng
- Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, China
| | - Sian M Griffiths
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Wong MC, Tam WW, Lao X, Wang HH, Kwan MW, Cheung CS, Tong EL, Cheung N, Yan BP, Yu C, Griffiths SM. The effectiveness of metoprolol versus atenolol on prevention of all-cause and cardiovascular mortality in a large Chinese population: A cohort study. Int J Cardiol 2014; 175:425-32. [DOI: 10.1016/j.ijcard.2014.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 06/12/2014] [Indexed: 11/30/2022]
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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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Jin CN, Yu CM, Sun JP, Fang F, Wen YN, Liu M, Lee APW. The healthcare burden of hypertension in Asia. HEART ASIA 2013; 5:238-43. [PMID: 27326143 DOI: 10.1136/heartasia-2013-010408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/05/2013] [Accepted: 10/29/2013] [Indexed: 01/11/2023]
Abstract
As the leading global risk for mortality, hypertension (HT) is a common healthcare problem in the world. The total number of patients with HT is likely to grow in the next few decades as the population age and the prevalence of obesity and diabetes increase. HT, as a major modifiable risk factor for cardiovascular disease, results in more deaths than any other risk factors, including diabetes and cigarette smoking. High prevalence, inadequate awareness, suboptimal treatment and low rate of achieving guideline-recommended target blood pressure control are key factors leading to severe cardiovascular complications that impose a heavy socioeconomic burden, especially in developing countries. Asia is the world's largest and most populous continent with approximately 4.3 billion people, hosting 60% of the world's current human population, and has a high growth rate. Asia differs very widely from the West with regard to ethnic groups, cultures, environments, economics, historical ties and government systems. Therefore, the purpose of this review is to comprehensively summarise the epidemiology, treatment practice and the status of control of HT in different Asian countries in order to guide the future prevention and management in this part of the world.
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Affiliation(s)
- Chun-Na Jin
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Jing-Ping Sun
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Fang Fang
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Yong-Na Wen
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Ming Liu
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
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Wong MC, Tam WW, Wang HH, Cheung CS, Tong EL, Sek AC, Cheung N, Yan BP, Yu C, Leeder SR, Griffiths SM. Predictors of the incidence of all-cause mortality and deaths due to diabetes and renal diseases among patients newly prescribed antihypertensive agents: a cohort study. Int J Cardiol 2013; 168:4705-10. [PMID: 23931979 PMCID: PMC7132417 DOI: 10.1016/j.ijcard.2013.07.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 07/18/2013] [Accepted: 07/20/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Randomized trials have shown that the major antihypertensive drug classes are similarly effective to reduce mortality, but whether these drug class difference exists in clinical practice has been scarcely explored. This study evaluated the association between antihypertensive drug class, all-cause mortality and deaths due to diabetes or renal disease in real-life clinical settings. METHODS A clinical database in Hong Kong included all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and grouped according to the initial antihypertensive prescription. The associations between antihypertensive drug class, all-cause mortality or combined diabetes and renal mortality, respectively, were evaluated by Cox proportional hazard models. RESULTS From 218,047 eligible patients, 33,288 (15.3%) died within five years after their first-ever antihypertensive prescription and among which 1055 patients (0.48%) died of diabetes or renal disease. After adjusted for age, gender, socioeconomic status, service settings, district of residence, medication adherence, and the number of comorbidities, each drug class was similarly likely to be associated with mortality due to diabetes or renal disease [Adjusted Hazard Ratios (AHR) ranged from 0.92 to 1.73, p=0.287-0.939] and all-cause mortality (AHR ranged from 0.83 to 1.02) except for beta-blockers (AHR=0.815, 95% C.I. 0.68-0.87, p=0.024) when ACEI was used as a reference group in propensity score-adjusted analysis. CONCLUSIONS These findings provide real-life evidence reinforcing that any major antihypertensive drug class is suitable as a first-line agent for management of hypertension as recommended by international guidelines.
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Affiliation(s)
- Martin C.S. Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wilson W.S. Tam
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Harry H.X. Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The 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
| | - Bryan P.Y. Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C.M. Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | | | - Sian M. Griffiths
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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18
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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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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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Wong MCS, Tam WWS, Cheung CSK, Wang HHX, Tong ELH, Sek ACH, Yan BPY, Cheung NT, Leeder S, Yu CM, Griffiths S. Drug adherence and the incidence of coronary heart disease- and stroke-specific mortality among 218,047 patients newly prescribed an antihypertensive medication: a five-year cohort study. Int J Cardiol 2012; 168:928-33. [PMID: 23174167 PMCID: PMC7114239 DOI: 10.1016/j.ijcard.2012.10.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/07/2012] [Accepted: 10/28/2012] [Indexed: 11/05/2022]
Abstract
Background Randomized trials have shown that optimal adherence to antihypertensive agents could protect against cardiovascular diseases, but whether adherence reduces cardiovascular deaths in community settings has not been explored so fully. This study evaluates the association between antihypertensive adherence and cardiovascular (coronary heart disease and stroke) mortality in the primary care settings. Methods From a territory-wide database in Hong Kong, we included all patients who were prescribed their first-ever antihypertensive agents in the years between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and assigned as having poor (Proportion of Days Covered [PDC] < 40%), intermediate (40–79%), and high (≥ 80%) adherence to antihypertensive agents. The association between antihypertensive adherence and cardiovascular mortality was evaluated by using the Cox proportional hazard models. Results From a total of 218,047 eligible patients, 3825 patients (1.75%) died of cardiovascular disease within five years after having received their first-ever antihypertensive agents. The proportions of patients having poor, intermediate, and high medication adherence were 32.9%, 12.1%, and 55.0%, respectively. Higher adherence levels at PDC 40%–79% (HR = 0.46, 95% C.I. 0.41–0.52, p < 0.001) and ≥ 80% (HR = 0.91, 95% C.I. 0.85–0.98, p = 0.012) were significantly less likely to be associated with mortality than the poor adherence (PDC0.040) group. Conclusions Better antihypertensive adherence was associated with lower cardiovascular mortality. This highlights the need to promote adherence through strategies which have been proved to be effective in clinical settings.
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Affiliation(s)
- Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
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Wong MCS, Jiang JY, Yan BP, Griffiths SM. Subjects at risk of discontinuation of lipid-lowering agents: a 6-month cohort study among 12,875 patients in a chinese population. Clin Ther 2011; 33:617-28. [PMID: 21665046 DOI: 10.1016/j.clinthera.2011.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dyslipidemia is a significant health problem, and persistent use of lipid-lowering agents among dyslipidemic patients is clinically important. However, few studies have evaluated the profiles of medication discontinuation among ethnic Chinese patients. OBJECTIVE The objective of this study was to evaluate the level of medication adherence among Chinese patients who were prescribed a lipid-lowering drug and to investigate factors that could help physicians identify patients at risk for discontinuing their medication. METHODS All patients who attended any primary care clinic in 1 territory of Hong Kong and were prescribed at least 1 lipid-lowering agent from January 2004 to June 2007 were included. The incidences of drug discontinuation within 180 days after drug prescriptions were measured, and the factors associated with discontinuation using binary logistic regression analyzes were evaluated. RESULTS Of the 12,875 eligible patients, the majority were prescribed fibrates (54.4%) and statins (45.1%). Among the patients, 17.0% discontinued their medication. Older patients (adjusted odds ratio [aOR] = 0.72-0.79 for patients >50 years), male subjects (aOR = 0.87; 95% CI, 0.78-0.97; P = 0.009), fee payers (aOR = 0.88; 95% CI, 0.78-0.99; P = 0.029), attendees in family medicine specialist clinics (aOR = 0.82; 95% CI, 0.70-0.96; P = 0.013), residents in rural districts (aOR = 0.52; 95% CI, 0.44-0.60; P < 0.001), follow-up visitors (aOR = 0.60; 95% CI, 0.54-0.66; P < 0.001), patients with comorbidities (aOR = 0.39; 95% CI, 0.35-0.44; P < 0.001 for 1 comorbidity and aOR = 0.28; 95% CI, 0.25-0.33; P < 0.001 for at least 2 comorbidities), and persons who use fibrates (aOR = 0.56; 95% CI, 0.49-0.64; P < 0.001) were significantly less likely to discontinue their medication. CONCLUSIONS The findings of these associated factors were new for ethnic Chinese patients. These findings could help physicians identify patients who had been prescribed a lipid-lowering agent who were at higher risk of discontinuing their medication. Their medication-taking behavior should be monitored more closely, and future studies should evaluate the reasons of drug discontinuation.
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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, China
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Abstract
AIMS Dyslipidaemia is a poorly-controlled condition in clinical practice largely because of poor adherence to medication regimens by patients. This study evaluated the levels of and factors associated with adherence to lipid-lowering agents in a large Chinese population. METHODS From a validated clinical database, we included all patients who attended any public, primary care clinics in one large Territory of Hong Kong for medication refill at least twice during the study period January 2004 to June 2007. The major outcome variable was Medication Possession Ratio (MPR), an internationally-recognised metric to measure drug adherence. The factors associated with optimal drug adherence (MPR ≥ 0.8) were evaluated by multivariate regression analysis. RESULTS From 11,042 eligible patients, 90% were adherent. After adjusting for patients' age, gender, socioeconomic status, service type, district of residence, visit type (new visits vs. follow-up visits), the number of comorbidities and the drug class (statin vs. fibrates), older patients [aged 50-59 years; adjusted odds ratio (AOR) 1.30, p = 0.009; 60-69 years; AOR 1.53, p < 0.001; ≥ 70 years; AOR 1.72, p < 0.001], attendance in family medicine specialist clinics (FMSC; AOR 1.56, p < 0.001), follow-up visits (AOR 2.93, p < 0.001) and the presence of comorbidities (one comorbidity; AOR 1.45, p < 0.001; ≥ 2 comorbidities; AOR 1.56, p < 0.001) were associated with optimal drug adherence. DISCUSSION AND CONCLUSION These findings carry an implication that younger subjects, new patients, visitors in clinics other than FMSC and those without comorbidities should receive more meticulous monitoring of their medication-taking behaviour. Future studies should evaluate the major reasons for non-adherence among them.
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Affiliation(s)
- M C S Wong
- Faculty of Medicine, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
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