Relationship of Blood Pressure Control to Adherence With Antihypertensive Monotherapy in 13 Managed Care Organizations

Abstract

ardiovascular disease, the leading cause of death and disability in the United States, is associated with inadequate blood pressure (BP) control.1,2 The relationship between BP and risk of cardiovascular events is positive, continuous, consistent, and independent of other risk factors. 2 Unfortunately, BP control is particularly poor among hypertensive patients at the highest risk for cardiovascular events, including patients with diabetes and older patients with systolic hypertension (HTN). 3Randomized controlled trials conducted over the last 4 decades have provided evidence to support the effectiveness of BP lowering to reduce the risks of cardiovascular disease. 4 Pharmacologic treatment of high BP can reduce the risk of stroke by 30% to 40% and myocardial infarction (MI) by 20% to 25%.5 Failure to reach BP treatment goals contributes to the burden of HTN complications. Results of the Cardiovascular Health Study suggest that undertreating systolic BP of >140 mm Hg accounts for 34% of strokes and 22% of MIs in older adults. 6 Recent population data indicate that only 31% of all hypertensive individuals are controlled to <140/90 mm Hg.3 Thus, almost 70% of the more than 50 million Americans with high BP are at increased risk of cardiovascular complications due to the failure to reach goal BP. 2Although poor BP control can be attributed to several factors, one pivotal reason is the problem of long-term patient compliance with therapy.7 Lack of compliance with BP-lowering medication is a major reason for poor control of BP.8 Reasons for poor compliance vary. Patients with high BP may fail to take their medication because of the chronic nature of HTN and its absence of overt symptoms; other reasons that have been studied include the adverse effects of medication, complicated drug ABSTRACT OBJECTIVE: This study was conducted to evaluate the relationship between medication compliance and blood pressure (BP) control among members of 13 managed care organizations with essential hypertension (HTN) who received antihypertensive monotherapy for at least 3 pharmacy claims prior to the blood pressure measurement.METHODS: This was a retrospective review of medical and pharmacy claims over a 4-year period (1999-2002) from 13 U.S. health plans. Data were collected by trained health professionals from randomly selected patient medical records per Health Plan Employer Data and Information Set (HEDIS) technical specifications. Patients were selected if they (1) had received monotherapy or fixed-dose combination therapy (administered in one tablet or capsule) during the time BP was measured (thus those with no BP drug therapy were excluded); (2) had received 3 or more antihypertensive pharmacy claims for the antihypertensive drug therapy prior to BP measurement; and (3) had one or more antihypertensive pharmacy claims after BP was measured. Control of BP was defined according to guidelines of the Sixth Report of the Joint National Committee (JNC 6) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (<140/...

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

“…Many studies demonstrated improved outcomes associated with better adherence to antihypertensives,5, 36 and nonadherence has been associated with increased risk for CVD, hospitalizations, and healthcare costs 5, 13, 14, 15, 16, 17, 37, 38, 39, 40, 41. In our study, around 60% of beneficiaries had PDC ≥80%, which is consistent with previous studies 9, 19.…”

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

“…Some studies suggest that chronic disease patients need to achieve 80 percent adherence to derive benefits from their medications. [14][15][16] We then defined a loss of adherence as being adherent in 2006 but being nonadherent in 2007. Similarly, we defined an increase in adherence as being nonadherent in 2006 and adherent in 2007.…”

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

“…Group-based trajectory models were used to identify and characterize patient subgroups following differential trajectories of adherence over time. 34,35 We first transformed the monthly PDC with oral hypoglycemics using the arcsine transformation, and modeled the monthly PDC using a censored normal distribution; the time variable was months since initiating treatment (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The purpose of the data transformation was to meet the assumption for the finite mixture trajectory model with a censored normal distribution for each trajectory.…”

“…4 Adherence is routinely measured based on prescription refills using administrative claims data. These claims-based measures are used in health plan quality ratings, in identifying non-adherent patients for targeted interventions by health systems, in research investigating the impact of medication non-adherence on clinical outcomes 3,[5][6][7][8][9] and in predicting health care costs and utilization. [10][11][12] However, most studies, and all current quality reporting measures, use a single adherence measure to represent average medication refills in a year (e.g., proportion of days covered [PDC] above a predefined threshold).…”