No abstract

METHOD Design and patientsData were pooled from five prospective, multicentre, pharmaco-epidemiological studies in which patients with hypertension, for whom first-line treatment either failed or was not tolerated, were treated for 90 days with one of several valsartan formulations as second-line therapy.Hypertension was defined as SBP of at ≥140 mmHg (≥130 mmHg for patients with concomitant diabetes) and/or DBP of ≥90 mmHg (≥80 mmHg for patients with concomitant diabetes). 9 The five studies had AimTo examine whether two simple, single-item physician-administered measures of patient adherence to antihypertensive medication are predictive of blood pressure outcomes. Design and settingRetrospective database analysis of patients with hypertension treated in Belgian primary care. MethodUsing pooled data from five observational studies, a sample was identified of 9725 patients who were assessed using two single-item physician-administered measures of adherence to antihypertensive medication: the first item of the Basel Assessment of Adherence Scale (BAAS) and the Visual Analogue Scale (VAS). These two assessment tools were administered by GPs during regular appointments with patients. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and combined SBP/DBP were measured at baseline and at 90 days. Results BAAS-identified ConclusionsThe first item of the BAAS and the VAS are independent predictors of blood pressure control. These methods can be integrated seamlessly into routine clinical practice by allowing GPs to quickly evaluate a patient's adherence and tailor treatment recommendations accordingly. Keywordshypertension; medication adherence; patient adherence; primary health care.Predicting blood pressure outcomes using single-item physician-administered measures:a retrospective pooled analysis of observational studies in Belgium

BACKGROUND: Comparative effectiveness research (CER) is a helpful approach to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision makers about the most effective interventions.

The authors used pooled data from 6 valsartan-related studies including 3983 adherent and 10,663 nonadherent patients to evaluate blood pressure (BP) outcomes in both groups after 90 days of treatment, applying hierarchical linear and logistic regression to identify determinants of BP outcomes. The principal findings were that: (1) BP outcomes were consistently better in adherent patients; (2) approximately a quarter of the variance in 90-day BP values was attributable to a physician class effect; (3) common and unique patient-and physician-related variables were associated with BP outcomes in both groups; (4) physician vigilance was associated with better outcomes, especially in adherent patients; and (5) adherent patients were more likely to exhibit target organ damage and associated events while being prescribed more complex medication regimens. Adherence to antihypertensive medication may be a function of prior line treatment failure, severity of illness, and sequelae, and the ensuing patient resolution to change medication behavior.J Clin Hypertens (Greenwich). 2013;15:663-673. ª2013 Wiley Periodicals, Inc.The prevalence of nonadherence has been estimated at 25% in general, 1 23% among patients with cardiovascular disease 1 and 50% among patients with hypertension.2,3 Nonadherence to antihypertensive medication is associated with a 30% loss of treatment effectiveness, 4 while adherence is associated with a 38% decreased risk of cardiovascular events.5 While blood pressure (BP) control is a challenge in general, 6-10 achieving BP targets is particularly difficult in nonadherent patients. 11Prior studies have focused mainly on identifying patient variables associated with nonadherence to antihypertensive medication, 12,13 even though the determinants of nonadherence are believed to be multifactorial and to include, among others, health care providers and treatment-related factors.14 Adherence behavior was a consistent determinant of BP outcomes in multivariate analyses in a series of large observational studies on second-line treatment of hypertension with various valsartan regimens conducted in Belgium. 15 We pooled the data of 6 of these studies to examine whether there were differences in BP outcomes between adherent and nonadherent patients after 90 days of treatment, the proportion of variance in BP outcomes attributable to a physician class effect, and the patient-and physician-related determinants of BP outcomes common across and unique in each of these groups. The 14,646 evaluable patients were classified as nonadherent if they recalled not having taken their medication at some time in the 4 weeks prior to the 90-day follow-up visit; if not, they were classified as adherent. While perhaps a crude criterion potentially subject to bias, we have reported elsewhere that such a simple query is highly predictive of BP outcomes. Table I summarizes the key characteristics of the studies from which the data were pooled. The common methodology of these studies has been described in detail elsewhere. 16 METHODS1...