Objectives We assessed whether socio-demographic, clinical, health care system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores among older men and women. Design / Setting A cross-sectional analysis using baseline data from the Cohort Study of Medication Adherence in Older Adults (CoSMO, n=2,194). Measurements Low antihypertensive medication adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Risk factors for low adherence were collected using telephone surveys and administrative databases. Results The prevalence of low medication adherence scores did not differ according to sex (15.0% in women and 13.1% in men p=0.208). In sex-specific multivariable models, having issues with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores among both men and women. Factors associated with low adherence scores in men but not women included reduced sexual functioning (OR = 2.03; 95% CI: 1.31, 3.16 for men and OR = 1.28; 95% CI: 0.90, 1.82 for women), and BMI ≥25 (OR = 3.23; 95% CI: 1.59, 6.59 for men and 1.23; 95% CI: 0.82, 1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75; 95% CI: 1.16, 2.65 for women and OR =1.16 95% CI: 0.57, 2.34 for men) and depressive symptoms (OR = 2.29; 95% CI: 1.55, 3.38 for women and OR = 0.93; 95% CI: 0.48, 1.80 for men). Conclusion Factors associated with low antihypertensive medication adherence scores differed according to sex. Interventions designed to improve adherence in older adults should be tailored to account for the sex of the target population.

Background Pharmacy refill adherence assesses medication-filling behaviors whereas self-report adherence assesses medication-taking behaviors. We contrasted the association of pharmacy refill and self-reported antihypertensive medication adherence with cardiovascular disease (CVD) incidence. Methods and Results Adults (n=2075) from the prospective Cohort Study of Medication Adherence among Older Adults (CoSMO) recruited between August 2006 and September 2007 were included. Antihypertensive medication adherence was determined using a pharmacy refill measure, Medication Possession Ratio-MPR (low, medium, high MPR: <0.5, 0.5 to <0.8, ≥0.8, respectively) and a self-reported measure, 8-item Morisky Medication Adherence Scale-MMAS-8 (low, medium, high MMAS-8: <6, 6 to <8, and 8, respectively). Incident CVD events (stroke, myocardial infarction, congestive heart failure, or CVD death) through February 2011 were identified and adjudicated. The prevalence of low, medium and high adherence was 4.5 %, 23.7%, and 71.8% for MPR and 14.0%, 34.3%, and 51.8% for MMAS-8. During a median 3.8 years follow-up, 240 (11.5%) people had a CVD event. After multivariable adjustment and compared to those with high MPR, the hazard ratios (HR) for CVD associated with medium and low MPR were 1.17 (95% confidence interval [CI] 0.87, 1.56) and 1.87 (95% CI: 1.06, 3.30), respectively. Compared to those with high MMAS-8, the HRs (95% CI) for MMAS-8 for medium and low MMAS-8 were 1.04 (0.79–1.38) and 0.89 (0.58–1.35), respectively. Conclusions Pharmacy refill but not self-report antihypertensive medication adherence was associated with incident CVD. The differences in these associations may be due to distinctions in what each adherence measure assesses.

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Objective To develop and evaluate a short self-report tool to predict low pharmacy refill adherence by using pharmacy refill data in older patients with uncontrolled hypertension. Design Cross-sectional analysis of survey and administrative data data from the Cohort Study of Medication Adherence among Older Adults (CoSMO). Participants Three hundred ninety-four adults with uncontrolled blood pressure; mean ± SD age was 76.6 ± 5.6 years, 33.0% were black, 66.0% were women, and 23.4% had a low medication possession ratio (MPR). Measurements and Main Results We considered 164 self-reported candidate items for development of a prediction rule for low (< 0.8) vs. high (≥ 0.8) MPR from pharmacy refill data. Risk prediction models were evaluated by using best subsets analyses, and the final model was chosen based on clinical relevance and model parsimony. Bootstrap simulations assessed internal validity. The performance of the final 4-item model was compared to the 8-item Morisky Medication Adherence Scale (MMAS-8) and the 9-item Hill-Bone Compliance Scale. The 4-item self-report tool for predicting pharmacy refill adherence showed moderate discrimination (C statistic 0.704, 95% CI 0.683–0.714) and good model fit (Hosmer-Lemeshow χ2 = 1.238, p=0.743). Sensitivity and specificity were 67.4% and 67.8%, respectively. The C statistics for MMAS-8 and the Hill-Bone Compliance Scale were lower at 0.665 (95% CI 0.632–0.683) and 0.660 (95% CI 0.622–0.674), respectively. Conclusion A 4-item self-report tool moderately discriminated low from high pharmacy refill adherers, and its test performance was comparable to existing 8- and 9-item adherence scales. Parsimonious self-report tools predicting low pharmacy refill in patients with uncontrolled blood pressure could facilitate hypertension management in the elderly.