Patient-Reported Reasons for Antihypertensive Medication Change: A Quantitative Study Using Social Media

Abstract

Introduction: Hypertension is the leading cause of heart disease in the world, and discontinuation or nonadherence of antihypertensive medication constitutes a significant global health concern. Patients with hypertension have high rates of medication nonadherence [13][14][15]. Studies of reasons for nonadherence using traditional surveys are limited, can be expensive, and suffer from response, whitecoat, and recall biases. Mining relevant posts by patients on social media is inexpensive and less impacted by the pressures and biases of formal surveys, which may provide direct insights into factors that lead to non-compliance with antihypertensive medication.Methods: This study examined medication ratings posted to WebMD, an online health forum that allows patients to post medication reviews. We used a previously developed natural language processing classifier to extract indications and reasons for changes in angiotensin receptor II blocker (ARBs) and angiotensin-converting enzyme inhibitor (ACEIs) treatments. After extraction, ratings were manually annotated and compared to data from the FAERS public database.Results: From a collection of 343,459 WebMD reviews, we automatically extracted 1,867 posts mentioning changes in ACEIs or ARBs, and manually reviewed the 300 most recent posts regarding ACEI treatments and the 300 most recent posts regarding ARB treatments. After excluding posts that only mentioned a dose change or were a false positive mention, 142 posts in the ARBs dataset and 187 posts in the ACEIs dataset remained. The majority of posts (97% ARBs, 91% ACEIs) indicated experiencing an adverse event as the reason for medication change. The most common adverse events reported mapped to the Medical Dictionary for Regulatory Activities were "musculoskeletal and connective tissue disorders" like muscle and joint pain for ARBs, and "respiratory, thoracic, and . mediastinal disorders" like cough and shortness of breath for ACEIs. These categories also had the largest differences in percentage points, appearing more frequently on WebMD data than FDA data (p=0.000).Conclusion: Musculoskeletal and respiratory symptoms were the most commonly reported adverse effects in social media postings associated with drug discontinuation. Managing such symptoms is a potential target of interventions seeking to improve medication persistence. Key Points1. The major reason for the discontinuation of ARBs and ACEIs expressed through WebMD was the experience of adverse events.2. Musculoskeletal and respiratory symptoms were the most commonly reported adverse effects in social media postings associated with drug discontinuation.3. This study shows the promise of WebMD mining as an effective tool in medication nonadherence and adverse event research.

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“…Medication nonadherence/discontinuation is an important issue in healthcare worldwide and it is a particular challenge for the treatment of chronic diseases. In the last few years, the role of social media in delivering patients personal experience following drug administration is becoming of great importance since it might influence other patients adherence to medical therapy [7]. Medication nonadherence/discontinuation may result in significant increase in adverse events and healthcare cost [7].…”

“…In the last few years, the role of social media in delivering patients personal experience following drug administration is becoming of great importance since it might influence other patients adherence to medical therapy [7]. Medication nonadherence/discontinuation may result in significant increase in adverse events and healthcare cost [7]. The nocebo effect, the inverse of the placebo effect, is a well-established phenomenon that is under-appreciated in cardiovascular medicine.…”