Antihypertensive medication adherence and blood pressure control among central Alabama veterans

Piercefield, Emily; Howard, Molly E.; Robinson, Michael H.; Kirk, Cain Eric; Ragan, Addison P.; Reese, Sondra D.

doi:10.1111/jch.12953

Cited by 19 publications

(27 citation statements)

References 32 publications

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“…Of the adherent patients, only 24% achieved their blood pressure targets. This percentage was similar to the value of 25% reported by Hussain et al [9], but was lower than the percentages reported by Gu et al [19] and Piercefield et al [28], who reported controlled blood pressure rates of 44% and 67.4%, respectively. In the present study, medication adherence was significantly associated with blood pressure control.…”

Section: Determinants Of Blood Pressure Control In the Tegal Alur Admsupporting

confidence: 82%

Determinants of Blood Pressure Control and Prevalence of Hypertension in Adults in 2017: A Population-Based Study in West Jakarta

Bawazir¹,

Sianipar²

2018

TOHYPERJ

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Background:The high prevalence of hypertension in developing countries underlines the need for accurate data on the prevalence of adult hypertension, as well as patient characteristics and determinants of blood pressure control. As this information is currently not available, our aim was to collect such data from a population of patients in the Tegal Alur Administrative Village, West Jakarta Indonesia.Objective:We conducted a case-control study (n = 152) to identify determinants of hypertension and a cross-sectional study (n = 3842) to determine hypertension prevalence and investigate determinants of blood pressure control in hypertensive adults (≥18 years old).Methods:The cross-sectional design involved the diagnosis of hypertension via home visits (active detection) and routine clinical examinations at the Tegal Alur II Community Health Center (passive detection). In the case-control design, the groups were sex-matched.Results:In 2017, the prevalence of hypertension in adults in Tegal Alur was 16.8% (n = 646), and the rate of uncontrolled hypertension was 89% (n = 572). A multivariate analysis showed that the adjusted prevalence ratio for comorbidities was 2.1 (95% confidence interval [CI]: 1.48–3.12;p= 0.005). A body mass index indicative of being overweight (≥23 kg/m2) had an odds ratio of 2.25 (95% CI: 1.14–4.44;p= 0.016).Conclusion:Comorbidities were the strongest predictor of uncontrolled blood pressure in hypertensive adults of Tegal Alur. Being overweight (BMI ≥23 kg/m2) was significantly associated with hypertension.

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Section: Determinants Of Blood Pressure Control In the Tegal Alur Admsupporting

confidence: 82%

Determinants of Blood Pressure Control and Prevalence of Hypertension in Adults in 2017: A Population-Based Study in West Jakarta

Bawazir¹,

Sianipar²

2018

TOHYPERJ

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“…An important contributor to these low rates of BP control is poor adherence to treatment . Indeed, a substantial proportion of patients do not adhere to antihypertensive treatment . In turn, poor adherence increases the risk for cardiovascular and all‐cause mortality …”

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confidence: 99%

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Satsoglou

Τζιόμαλος

2018

J of Clinical Hypertension

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Hypertension is a major modifiable cardiovascular risk factor. [1][2][3] Several studies have shown that management of hypertension with all five main classes of blood pressure (BP)-lowering drugs (diuretics, β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers) substantially reduces cardiovascular morbidity and mortality. 4 However, only a minority of patients with hypertension achieve BP targets. 5-7 An important contributor to these low rates of BP control is poor adherence to treatment. 8 Indeed, a substantial proportion of patients do not adhere to antihypertensive treatment. 8,9 In turn, poor adherence increases the risk for cardiovascular and all-cause mortality. 10,11 Several predictors of nonadherence to antihypertensive treatment have been identified, including older age, belonging to a racial/ethnic minority, male sex, and depression. 8,12 Moreover, several studies have shown that an increase in the number of antihypertensive agents is associated with reduced adherence to treatment. 8,12 This observation is particularly pertinent for the management of hypertension, since most patients with hypertension require more than one agent to achieve BP targets. 13,14 In this context, a meta-analysis by Du and colleagues 15 offers valuable information in the effort to improve adherence to antihypertensive treatment. The authors analyzed nine studies in 62 481 patients with hypertension and report that the mean difference of medication adherence for fixed-dose combination (FDC) vs freeequivalent combination therapies was 14.92% (95% confidence interval, 7.38%-22.46%). 15 Moreover, patients in the FDC group were nearly two times more likely to adhere to their antihypertensive treatment (risk ratio, 1.84, 95% confidence interval, 1.00-3.39). 15 Despite the important findings reported in this meta-analysis, there are still unanswered questions regarding the role of FDCs in the management of hypertension. First, eight of nine studies included in the meta-analysis by Du and coworkers 15 were retrospective. More prospective studies are needed to clearly define the benefits of FDCs. Moreover, this meta-analysis did not evaluate whether different types of FDCs (eg, renin-angiotensin system inhibitors combined with diuretics vs renin-angiotensin system inhibitors combined with calcium channel blockers) have the same impact on adherence. 15 It appears that adherence to diuretics is lower than with other antihypertensive agents. 12 On the other hand, calcium channel blocker use was reported to be independently associated with lower risk for decline in adherence. 16 This question has particular importance, since in the ACCOMPLISH (Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension) trial, combining an angiotensin-converting enzyme inhibitor with a calcium channel blocker reduced cardiovascular events more than the combination with a diuretic, despite a similar reduction in BP. 17 Third, only fixed combinations o...

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“…Single-class adherence was highest for ARBs (75.6%) and lowest for BBs (64.7%). 43 In a study in Comilla, Bangladesh, has also revealed that single drug regimen and cheaper drugs ensure better compliance. Polypharmacy was responsible for non-adherence.…”

Section: Methods-mentioning

confidence: 99%

Nonadherence to Drugs among the Hypertensive Patients in Outpatient Department of a Secondary Hospital of Bangladesh

Ullah¹,

Saha²,

Rahman³

et al. 2019

Cardiovasc. j.

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Background: One fifth Bangladeshi adults are hypertensive. Forty percent of them know that they are hypertensive. 53% to 75% hypertensive people have got uncontrolled hypertension. One of the most important causes of uncontrolled hypertension is nonadherence to drugs. We tried to find the causes of non adherence of drugs among the patients with HTN in a secondary care hospital of Bangladesh. Methods: The study was conducted from March 2018 to June 2018. Total 144 patients with HTN were included in the study. Taking drugs in less than 80% of the days of previous six months was defined as nonadherence. We used Hill Bone compliance scale to find out the causes of nonadherence to drugs. Results: Out of 144 patients 79 patients (55%) were non adherent to drugs. 36.8% patients forget to take their drugs, 34.02% patients run out of drugs, 29.86% patients miss taking drugs when they feel better, 15.27% patients skip their drugs before going to the doctor and 14.58% patients decide not to take drugs anymore without any specific reason. In most of the patients there are more than one causes of nonadherence. 85.9% patients with nonadherence had uncontrolled hypertension and 66.6 % of the nonadherent patients had target organ damage. Nonadherence is more in elderly patients and with increased duration of hypertension. Conclusion: Fifty five percent of the diagnosed hypertensive population is nonadherent to their drugs. We must take measures to diagnose HTN among our population and find the ways to make them adherent to their treatment. Cardiovasc. j. 2019; 11(2): 105-113

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Antihypertensive medication adherence and blood pressure control among central Alabama veterans

Cited by 19 publications

References 32 publications

Determinants of Blood Pressure Control and Prevalence of Hypertension in Adults in 2017: A Population-Based Study in West Jakarta

Determinants of Blood Pressure Control and Prevalence of Hypertension in Adults in 2017: A Population-Based Study in West Jakarta

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Nonadherence to Drugs among the Hypertensive Patients in Outpatient Department of a Secondary Hospital of Bangladesh

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