Antihypertensive Drug Adherence Among 6408 Chinese Patients on Angiotensin‐Converting Enzyme Inhibitors in Hong Kong: A Cohort Study

Abstract

Few studies have addressed the profile of adherence among ethnic Chinese patients. This study evaluated the factors associated with adherence with angiotensin-converting enzyme inhibitors (ACEIs), an increasingly common antihypertensive drug of choice. The authors included all adult patients who were prescribed an ACEI and paid at least 2 consecutive visits to any primary care clinics of one large territory of Hong Kong from January 2004 to June 2007. The determinants of good adherence to ACEI, as defined by a medication possession ratio > or = 80%, were evaluated by multivariate regression analysis. From 6408 eligible patients, 88.0% were adherent. Patients attending family medicine specialist clinics (adjusted odds ratio [AOR] = 1.46, 95% confidence interval [CI]: 1.12-1.91, P = .005) and follow-up visitors (AOR = 2.98, 95% CI: 2.49-3.55, P < .001) were significantly more likely and attendees of staff clinics (AOR = 0.48, 95% CI: 0.25-0.94, P = .033) were less likely to be adherent to ACEIs. Patients' age, gender, socioeconomic status, district of residence, and the number of comorbidities were not found to be associated with good adherence. Adherence-enhancing strategies should therefore be particularly focused on the new visitors (likely to be drug naive), and future research directions should delineate the best health service setting that could facilitate adherence to ACEIs.

Non-Adherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

“…However, a few studies identified hypertensive patients with comorbidities and the number of medications prescribed are the 2 significant factors associated with poor adherence. [45,47,48] In contrast, our findings showed that only one-third (31.2%) of hypertensive patients with comorbidities showed nonadherence to antihypertensive medications and was not strongly associated for nonadherence (P = 0.045). Evidence from the recent meta-analysis suggests that a 10 mm Hg reduction in systolic BP in hypertensive patients reduces the risk of major CVD events by 20%, CHDs by 17%, stroke by 27%, heart failure by 28%, and all-cause mortality by 13%.…”

Cardiovascular mortality in hypertensive patients newly prescribed perindopril vs. lisinopril: A 5-year cohort study of 15,622 Chinese subjects

“…Any changes of prescriptions after the initial consultation were also recorded. This database had also been described in previous publications [24][25][26][27][28][29][30][31][32][33]. The database was previously validated and demonstrated a high level of completeness on the sociodemographic information (100%) and prescription profiles (99.8%) [27].…”

Duration of initial antihypertensive prescription and medication adherence: A cohort study among 203,259 newly diagnosed hypertensive patients

“…This study used an electronic Clinical Management System (CMS) in Hong Kong, which has been previously described in details [21][22][23][24][25][26][27][28][29][30]. The electronic healthcare records capture information on patients' demographics, prescription details, and clinical diagnoses, which were coded by the International Classification of Diseases (ICD-9 and ICD-10) or the International Classification of Primary Care (ICPC-2).…”

“…Previous studies on the determinants of medication adherence mostly focused on patients' socio-demographic factors and the service settings [21][22][23][24][25][26][27][28][29][30]. The World Health Organization (WHO) has identified evidence for early action to enhance adherence with long-term therapies, and antihypertensive prescription is among one of them [11].…”