Sex differences in adherence to antihypertensive treatment in patients aged above 55: The French League Against Hypertension Survey (FLAHS)

Abstract

Despite the availability of efficient therapies to reduce the risk of cardiovascular complications, poor adherence to antihypertensive (anti‐HTN) drugs is frequent, especially during the first year of treatment and among uncontrolled/resistant hypertensive patients. The aim of the study was to identify factors associated with adherence to anti‐HTN treatment and to examine whether they differ across sex. A total of 2743 treated hypertensive participants to the cross‐sectional Metascope survey (France, 2015) aged 55 years or more were included. The authors measured adherence to anti‐HTN treatment using the 6‐item Girerd compliance test. Variations in adherence were examined using the Rao‐Scott statistics and Poisson regression. Overall, 63.6% of participants were adherent to anti‐HTN treatment. Adherence was more frequent among women than men (69% vs 58%, P < 10−4). For both sexes, level of adherence was positively associated with age (P < 10−4), but inversely associated with number of anti‐HTN tablets, number of tablets taken for metabolic diseases, history of cardiovascular diseases, number of other chronic diseases (all P < 10−4). The inverse relationship between adherence and the number of anti‐HTN tablets significantly differed between sexes (P < 10−4): Adherence decreased sharply when taking two or more anti‐HTN tablets in men, whereas the decrease in women was only observed when taking three or more anti‐HTN tablets. This study suggests that adherence to anti‐HTN treatment is higher among women, decreases with the number of tablets prescribed, and differentially so across sex. Reducing the number of tablets for anti‐HTN treatment may improve adherence, especially among men and patients with multiple comorbidities.

Analysis of blood pressure control in outpatients with non-dialysis chronic kidney disease referred by primary care physicians: a study from the centre of nephrology care

“…Females achieved BP goals more often, regardless of chosen standard, which may be related to higher adherence to antihypertensive treatment [24]. Patients who achieved BP goals had the similar age, BMI, CKD and HTN duration, and DM prevalence as the whole cohort of hypertensive patients.…”

Drugs don’t work in patients who don’t take them

“…However, Berntson et al reported that depression, as defined by the PHQ‐9, was not associated with self‐reported poorer adherence to antihypertensive drugs or cholesterol‐lowering drugs in a large sample representative of the US population (the 2005‐2010 National Health and Nutrition Examination Survey) . In the study reported in this Journal, a study of Japanese patients with CVD, more than 2× daily dosing frequency, age <65 years, and active employment were significantly associated with nonadherence (OR 4.42 CI 3.02‐6.48; 1.7 CI 1.23‐2.35, and 1.43 CI1.03‐1.99), respectively; but, depression was not a significant factor in nonadherence …”

“…In the current issue of JCC, Lefort et al report on gender differences in adherence to antihypertensive treatment in a study of French men and women >55 years of age . (gender differences in medication adherence have not been well studied).…”

“…15 In the study reported in this Journal, a study of Japanese patients with CVD, more than 2× daily dosing frequency, age <65 years, and active employment were significantly associated with nonadherence (OR 4.42 CI 3.02-6.48; 1.7 CI 1.23-2.35, and 1.43 CI1.03-1.99), respectively; but, depression was not a significant factor in nonadherence. 16 Adherence has frequently been defined using a cut-off point of ≥80%. Self-reported nonadherence rates (commonly determined using the Morisky scale) are usually lower than the rates obtained with other methods, such as electronic monitoring, because self-reports are known to be limited by a subject's reluctance to disclose nonadherence.…”

“…In the current issue of JCC, Lefort et al report on gender differences in adherence to antihypertensive treatment in a study of French men and women >55 years of age. 16 (gender differences in medication adherence have not been well studied). Their study is a cross-sectional survey based upon 20 000 households recruited by quota sampling "in order to ensure representativeness of the French population."…”