Adherence to antihypertensive medications: is prescribing the right pill enough?

Gosmanova, Elvira O.; Kövesdy, Csaba P.

doi:10.1093/ndt/gfu330

Cited by 35 publications

(53 citation statements)

References 76 publications

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“…We utilized a pharmacy database analysis to assess two parts of medication adherence: adherence and persistence. (21) Inadequate adherence to cardiovascular pharmacotherapy was associated with reduced survival, independent of demographic, co-morbidity and laboratory characteristics.…”

Section: Discussionmentioning

confidence: 98%

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Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis

Molnár

Gosmanova

Sumida

et al. 2016

American Journal of Kidney Diseases

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Background Medication non-adherence is a known risk factor for adverse outcomes in the general population. However, little is known about the association of pre-dialysis medication adherence among patients with advanced chronic kidney disease with mortality following their transition to dialysis. Study Design Observational study. Setting & Participants 32,348 US veterans who transitioned to dialysis during 2007–2011. Predictors Adherence to treatment with cardiovascular drugs, ascertained from pharmacy database records using proportion of days covered (PDC) and persistence during the pre-dialysis year. Outcomes Post-dialysis initiation all-cause and cardiovascular mortality, using Cox models with adjustment for confounders. Results The mean age of the cohort was 72±11 (SD) years, among whom 96% were male, 74% were white, 23% were African American, and 69% were diabetic. During median follow-up of 23 (IQR, 9–36) months, 18,608 patients died. Among patients with PDC >80%, there were 14,006 deaths (mortality rate, 283 [95% CI, 278–288]/1000 patient-years [PY]); among patients with PDC >60%–80%, there were 3,882 deaths (mortality rate, 294 [95% CI, 285–304]/1000 PY); among patients with PDC ≤60%, there were 720 deaths (mortality rate, 291 [95% CI, 271–313]/1000 PY). Compared to patients with PDC >80%, adjusted HR for post-dialysis initiation all-cause mortality for patients with PDC >60%–80% was 1.12 (95% CI, 1.08–1.16) and for patients with PDC ≤60% was 1.21 (95% CI, 1.11–1.30). In addition, compared to patients showing medication persistence, adjusted HR risk for post-dialysis initiation all-cause mortality for patients with non-persistence was 1.11 (95% CI, 1.05–1.16). A similar trend was detected for cardiovascular mortality and in subgroup analyses. Limitations Large number of missing values; the results may not be generalizable to women or the general US population. Conclusions Pre-dialysis cardiovascular medication non-adherence is an independent risk factor for post-dialysis mortality among advanced chronic kidney disease patients transitioning to dialysis. Further studies are needed to assess whether interventions targeting adherence improve survival after dialysis initiation.

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Section: Discussionmentioning

confidence: 98%

“…Therefore, providers should be familiar with available methods for adherence screening(21) and routinely apply them while treating patients with CKD. The PDC, MPR, and persistence methods that were used in the current study are indirect screening methods for the evaluation of medication-taking behavior based on pharmacy database evaluation.…”

Section: Discussionmentioning

confidence: 99%

Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis

Molnár

Gosmanova

Sumida

et al. 2016

American Journal of Kidney Diseases

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“…1-5 A recent review of non-adherence also underscored the link to complications of hypertension and suggested routine screening. 6 In addition, low medication adherence has been shown to be associated with adverse safety events. 7 Several factors can influence patient medication adherence, such as complexity of regimen including number of medications; lack of knowledge about the disease; and medication side effects, including their impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study

Haley

Gilbert

Riley

et al. 2016

Journal of the American Society of Hypertension

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We examined baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT) to investigate whether medication adherence, measured by the Morisky Medication Adherence Scale (MMAS-8), was associated with systolic blood pressure (SBP), and whether MMAS-8 score and number of antihypertensive medications interacted in influencing SBP. 8,435 SPRINT participants were included: 21.2% had low adherence (MMAS-8: <6); 40.0% had medium adherence (6 to <8); and 38.8% had high adherence (8). SBP was <140 mmHg in 54.6%; 140 – 160 mmHg in 36.6%; and >160 mmHg in 8.8%. In multivariable regression, medium vs. low adherence weakly associated with lower SBP (OR: 1.17, CI: 1.04, 1.31). SPRINT eligibility criteria should be considered when interpreting results. Efforts to understand and enhance adherence are crucial to improve population health and using self-report instruments might be considered for predicting treatment adherence and response in future efficacy trials and for identifying patients for adherence support in clinical practice.

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“…Bu davranış birçok faktörden etkilenmektedir. Dünya Sağlık Örgütü bu faktörleri beş geniş kategoride sınıflandırmaktadır: hasta ile ilgili, durumla ilgili, tedavi ile ilgili, sosyo-ekonomik ve sağlık sistemi ile ilgili faktörlerdir (31). Çalışmamızda 65 yaş altı kişilerin tedaviye uyum ve farkındalık sürecinde ilkokul ve üstü öğrenim görenlerin, hipertansiyon süresi 10 yıl ve üstü olan hastaların düzenli kan basıncı ölçümü yaptırmaması ve hekim kontrolüne gelirken ölçüm sonuçlarını beraberinde getirmemeleri gibi çoklu faktörlerin etkili olduğunu göstermektedir.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Neunclassified

Hemodiyaliz Hastalarının Hipertansiyon Yönetimine İlişkin Evde Yaptıkları Uygulamalar

Gökdoğan¹,

Kes²,

Turgay³

et al. 2017

Turk Neph Dial Transpl

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Öz aMaÇ: Bu araştırmanın amacı, hemodiyaliz hastalarının hipertansiyon yönetimine ilişkin evde yaptıkları uygulamaları belirlemektir. GEREÇ ve YÖnTEMLER:Tanımlayıcı nitelikte yapılan çalışmanın evrenini Karabük ili sınırlarında bulunan iki devlet, bir özel ve bir eğitim araştırma hastanesi hemodiyaliz merkezinde tedavi gören toplam 279 hasta oluşturdu. Örneklemde ise 18 yaş üstü, hipertansiyonu olan, iletişim kurabilen, klinik durumu stabil olan, mental ve psikiyatrik rahatsızlığı olmayan, araştırmaya gönüllü olarak katılmayı kabul eden 120 hasta yer aldı.BuLGuLAR: Araştırmaya katılan hastaların %59,2'sinin evde kan basınçlarını düzenli olarak ölçmedikleri; %44,6'ünün ilaçlarını düzenli olarak kullanmadıkları, ilaçlarının adını ve dozunu bilmedikleri (sırasıyla % 60,7, % 64,3); %73,2'sinin hekim bilgisi dışında ilaçlarını kullanmayı bıraktıkları;%85'inin yemeklerinde tuz kullandığı ve %46,7'sinin sıvı kısıtlamasına uyum göstermediği saptandı.SOnuÇ: Hemodiyaliz hastalarının bireysel özelliklerine göre evde hipertansiyon yönetimine ilişkin düzenli eğitim, izlem ve danışmanlık yapılarak öz yönetimlerinin güçlendirilmesinde hemşirelik bakım yaklaşımının etkilerinin çalışmalarla ortaya konması önemli görünmektedir.AnAhTAR SÖzcükLER: Hipertansiyon, Hemodiyaliz, Hemşirelik, Evde bakım ABSTRAcTOBJEcTIVE: This study aimed to determine home application by hemodialysis patients for hypertension management. MATERIAL and METhOdS:The population of the descriptive study included a total of 279 patients who were treated at the hemodialysis centers of two state hospitals, one private hospital and one training and research hospital situated within Karabük province. A total of 120 patients who were over 18 years of age, had hypertension, could communicate, and whose clinic state were stable, who did not have any mental and psychiatric disorder and who accepted to participate in the research voluntarily were included in the sample. RESuLTS:It was determined that 59.2% of the patients who participated in the study did not measure their blood pressures at home regularly; 44.6% did not take their medication regularly and did not know the name and dosages of their medication (60.7% and 64.3% respectively); 73.2% had stopped taking medication without the physician's knowledge; 85% used salt in meals; and 70.8% and 46.7% respectively did not comply with the liquid limitation. cOncLuSIOn:It is important to reveal the effects of a nursing care approach for supporting hypertension self-management at home of our patients based on their individual characteristics through studies focusing on regular training, monitoring and providing consultancy services.

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Adherence to antihypertensive medications: is prescribing the right pill enough?

Cited by 35 publications

References 76 publications

Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis

Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis

The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study

Hemodiyaliz Hastalarının Hipertansiyon Yönetimine İlişkin Evde Yaptıkları Uygulamalar

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