Suitability of antiplatelet therapy in hypertensive patients

Abstract

Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

“…From the individualized analysis of each of these variables, based on their measures of association according to the odds ratios obtained (Table 1), we will be able to design strategies focused on reducing non-adherence in these complex patients to improve control of their chronic diseases. Examination of other studies found no consistency regarding the relationship between non-adherence and dependent socioeconomic, demographic and work-family factors [5][6][7][8][9][10][11][12][13][14][15][16], although all the authors agree that non-adherence is associated with greater therapeutic complexity and a poorer doctor-patient relationship [17][18][19][20][21][22][23][24][25].…”

“…In other studies, the most consistent factors found to be associated with greater pharmacological non-adherence are those dependent on therapeutic complexity, such that patients with multiple diseases and multiple medications have a higher probability of nonadherence to pharmacological treatment [17][18][19][20][21][22][23][24][25]. Few studies use a holistic approach to address therapeutic adherence in chronic patients, as most studies focus on specific chronic diseases such as hypertension, DM, dyslipidaemia, depression or osteoporosis [5][6][7][8][9][17][18][19][20][21][22][23][24][25].…”

“…In Spain, community pharmacies are ideal places not only to measure and investigate therapeutic non-adherence, but also to carry out interventions to help reduce pharmacological non-adherence in chronic patients [23][24][25][26]. The majority of studies undertaken on therapeutic adherence have been conducted in primary care or specialized care [5][6][7][8][17][18][19][20][21][22][23][24][25], but fewer studies are conducted in pharmacies [27][28][29].…”

Analysing the concept of diagnostic inertia in hypertension: a cross-sectional study

“…In 2001, Phillips introduced the concept of clinical inertia, defining it as failure by the physician to initiate or intensify treatment when this action was indicated . This inertia, coupled with poor medication adherence by the patient, is considered the main cause of poor control of chronic diseases such as hypertension .…”

A four-year cardiovascular risk score for type 2 diabetic inpatients

“…The study population was formed by diabetic patients admitted via the ED in the Valle de Elda healthcare area (Valencian community), an industrial area with 198,090 inhabitants with a low-to-medium socioeconomic level ( Martínez-Orozco et al, 2015 ). The ED of Elda Hospital (a public institution) tends to about 160 general emergency cases daily among the adult population, not including obstetric and gynaecologic cases ( Carbonell Torregrosa et al, 2014 ).…”