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/...

Fixed-dose amlodipine-benazepril was associated with higher adherence rates versus an ACE inhibitor plus a dihydropyridine CCB taken as two separate tablets, regardless of the number of concomitant medications prescribed.

Chronic ingestion of ethanol in alcoholic beverages can impair drug therapy, lead to sometimes hazardous interactions, or compromise adherence to a well-planned drug treatment program. Various drugs consistently interact with alcohol: CNS depressants, such as benzodiazepines, barbiturates, muscle relaxants, antihistamines, and psychotropic agents; analgesics, including aspirin and narcotics; anticoagulants and other cardiovascular drugs, namely digitalis glycosides, diuretics, antihypertensives, and antiarrhythmics; and antidiabetic agents. Abstinence from alcohol by elderly patients receiving these drugs is recommended.Since 95 million Americans consume alcoholic beverages on a regular basis and approximately 9 million more are alcohol-dependent,' it comes as no surprise that 61 per cent of persons over the age of 50 drink alcohol. In addition, the use of medications by the elderly is twice that of younger counterparts, and accounts for well over 25 per cent of all prescription and over-the-counter drug purchases in the United States.* This is substantial when one considers that those 65 years old or older represent only 11 per cent of the population of the United States.Elderly patients visiting private physicians regularly receive or renew at least one or two prescription drugs per visit. Patients in nursing homes are routinely maintained on four to six medications. Studies of prescribing patterns in hospitals and private offices indicate that cardiovascular agents, diuretics, aspirin and narcotic-containing analgesics, and psychotropics are the classes of drugs most frequently prescribed for elderly patientsS3s4 These agents also account for the greatest number of drug-related hospital admissions of the elderlya5 It is a sobering coincidence that clinically troublesome drug-alcohol interactions occur with the same classes of drugs.Alcohol use may lead to a variety of metabolic and organ system derangements. It can impair the effectiveness of routine drug therapy, or actively create new medical problems requiring additional therapy. Excessive alcohol use in association with medications in the elderly can severly compromise and complicate a well-planned therapeutic program. Even the moderate or intermittent use of alcohol can be harmful if the patient is taking certain of the potentially interacting drugs.

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Guidelines for the safe, effective use of antacids and laxatives are presented, with emphasis on the special problems and considerations of their use in the elderly. Discussed are properties affecting drug selection, dosage, measures to ensure compliance, adverse reactions, and drug interactions. Physician–patient dialogs are recommended, as is patient education about the dangers of inappropriate or excessive use of these products, and the need to obtain medical care for unremitting symptoms.