Low Medication Adherence and the Incidence of Stroke Symptoms Among Individuals With Hypertension: The REGARDS Study

Abstract

We analyzed data on 9,950 participants taking antihypertensive medications in the nationwide REGARDS study to determine the association between medication adherence and incident stroke symptoms. Medication adherence was assessed using a validated 4-item self-report scale and participants were categorized into four groups (scores of 0, 1, 2, and 3 or 4 with higher scores indicating worse adherence). The incidence of six stroke symptoms (sudden weakness on one side of the body, numbness, painless loss of vision in one or both eyes, loss of half vision, losing the ability to understand people, and losing the ability to express oneself verbally or in writing) was assessed via telephone interviews every six months. Over a median of 4 years, the incidence of any stroke symptom was 14.6%, 17.9%, 20.2%, and 24.9% among participants with adherence scores of 0, 1, 2, and 3 or 4, respectively (p-trend<0.001). The multivariable adjusted hazard ratio (95% confidence interval) for any stroke symptom associated with adherence scores of 1, 2, and 3 or 4, versus 0, was 1.20 (1.04–1.39), 1.23 (0.94–1.60), and 1.59 (1.08–2.33), respectively (p-trend<0.001). Worse adherence was also associated with higher multivariable adjusted hazard ratios for each of the six stroke symptoms.

Validation of the 5-Item Medication Adherence Report Scale in Older Stroke Patients in Iran

“…6 Researchers have identified 1 cause of recurrence to be medication nonadherence, because some studies have shown positive relationships between lower medication adherence and greater incidences of stroke symptoms. 7,8 Guidelines for secondary prevention after stroke have explicitly recommended using appropriate medication to control or reduce both blood pressure and cholesterol level. 9,10 Therefore, promoting medication adherence among stroke patients is critical, and investigating the potential determinants for medication adherence among patients having stroke is important.…”

Physician–Pharmacist Collaborative Management

“…26 These individuals were responsible for tasks such as: encouraging collaboration, instilling enthusiasm and cooperation in team members in order to overcome barriers to proper treatment implementation, and resolving problems with the intervention. These providers then gave the same training to their local offices.…”

Pharmacist intervention for blood pressure control: medication intensification and adherence

“…The regional training sessions were led by a physician/pharmacist team from one community-based Family Medicine program that successfully implemented the intervention model in a previous study. 5 These individuals addressed important issues for study offices, encouraged physicians to improve participation, instilled confidence and enthusiasm in in team members and addressed common barriers to treatment implementation and BP control and how they can be overcome. The training sessions discussed strategies to effectively implement the PPCM intervention and focused on strategies found to be most effective to overcome clinical inertia, adverse drug reactions and poor medication adherence.…”

“…heart failure, myocardial infarction, stroke). 5–8 For example, in a study of outpatients with established coronary heart disease, non-adherent patients, defined as following prescribed medication directions less than 75% of the time, were found to be 2.3 more likely to have a CV event when compared to their adherent counterparts. 8 Patients from minority populations have higher than average rates of non-adherence and CV events, 9,10 making them an important priority for treatment improvement efforts.…”