Relationship of Blood Pressure Control and Hospitalization Risk to Medication Adherence Among Patients With Hypertension in Taiwan

Wu, Ping; Yang, Chuh Yuh; Yao, Zhi; Lin, Wei Zhan; Wu, Li Chiu; Chang, Chih Ching

doi:10.1038/ajh.2009.210

Cited by 73 publications

(72 citation statements)

References 27 publications

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“…Our study provides further support for previous findings 12,13,31 about the association of adherence to antihypertensive medication on hospitalization for CVD. Compared with those patients with good medication adherence, patients with poor adherence were 1.42× more likely to require hospitalization for AMI.…”

Section: Discussionsupporting

confidence: 90%

“…A meta-analysis reported that patients adherent to antihypertensive medications showed better blood pressure control, compared with those who were nonadherent (odds ratio, 3.44; 95% confidence interval [CI], 1.60-7.37). 11 Evidence is mounting that patients who show poor adherence to antihypertensive medication have a higher risk of adverse outcomes, including allcause hospitalization and CVD hospitalization, 12,13 and they have higher healthcare costs 14 compared with patients with good adherence. 12,13,15 A recent cohort study 15 reported that a good-adherence group had a significantly lower incidence of acute cardiovascular events, compared with a group with poor adherence to antihypertension medication (hazard ratio [HR], 0.62; 95% CI, 0.40-0.96).…”

mentioning

confidence: 99%

“…11 Evidence is mounting that patients who show poor adherence to antihypertensive medication have a higher risk of adverse outcomes, including allcause hospitalization and CVD hospitalization, 12,13 and they have higher healthcare costs 14 compared with patients with good adherence. 12,13,15 A recent cohort study 15 reported that a good-adherence group had a significantly lower incidence of acute cardiovascular events, compared with a group with poor adherence to antihypertension medication (hazard ratio [HR], 0.62; 95% CI, 0.40-0.96). Pittman et al 16 also reported that patients with a medication adherence of ≥80% decreased their risk of CVD-related hospitalization by 33% (odds ratio, 1.33; 95% CI, 1.25-1.41) and emergency department visits by 45% (odds ratio, 1.45; 95% CI, 1.33-1.58).…”

mentioning

confidence: 99%

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Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications

Kim¹,

et al. 2016

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506C ardiovascular diseases (CVDs) are a leading cause of death in the world. High blood pressure contributes to ≈54% of stroke and 47% of IHD worldwide.1 Managing blood pressure in hypertensive patients is important for the prevention of CVD and the reduction of mortality. 2,3 The use of antihypertensive drug therapy reduces the risk of stroke by an estimated 34% and the risk of IHD by 21%. 4 The definition of medication adherence is that patients take their medications as prescribed, as well as continuing to take a prescribed medication based on the treatment alliance established between the patient and the physician. 5 Adherence to medication among patients with chronic diseases is suboptimal, dropping most dramatically during the first year after the start of therapy. 6,7 For example, half of the patients who are prescribed an antihypertensive drug will discontinue their medication within 1 year of starting the therapy. [8][9][10] Patients with chronic diseases require a good partnership with their physician in order to achieve the long-term outcome goal. Patients who are adherent to antihypertensive drugs are more likely to achieve blood pressure control. A meta-analysis reported that patients adherent to antihypertensive medications showed better blood pressure control, compared with those who were nonadherent (odds ratio, 3.44; 95% confidence interval [CI], 1.60-7.37).11 Evidence is mounting that patients who show poor adherence to antihypertensive medication have a higher risk of adverse outcomes, including allcause hospitalization and CVD hospitalization, 12,13 and they have higher healthcare costs 14 compared with patients with good adherence. 12,13,15 A recent cohort study 15 reported that a good-adherence group had a significantly lower incidence of acute cardiovascular events, compared with a group with poor adherence to antihypertension medication (hazard ratio [HR], Abstract-The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor...

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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confidence: 99%

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Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications

Kim¹,

et al. 2016

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“…[19][20][21][22][23][24][25] Our secondary outcome was time to first allcause hospitalization/ED visit during the 12 months after the first year of treatment, given that medication non-adherence may manifest as numerous different adverse outcomes (e.g., falls) and, therefore, increase the risk of all-cause hospitalizations/ED visits. 3,[26][27][28][29] Exposures: Adherence to Oral Hypoglycemics…”

Section: Outcome Measuresmentioning

confidence: 99%

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

et al. 2016

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BACKGROUND: Numerous interventions are available to boost medication adherence, but the targeting of these interventions often relies on crude measures of poor adherence. Group-based trajectory models identify individuals with similar longitudinal prescription filling patterns. Identifying distinct adherence trajectories may be more useful for targeting interventions, although the association between adherence trajectories and clinical outcomes is unknown. OBJECTIVE: To examine the association between adherence trajectories for oral hypoglycemics and subsequent hospitalizations among diabetes patients. DESIGN: Retrospective cohort study. PATIENTS: A total of 16,256 Pennsylvania Medicaid enrollees, non-dually eligible for Medicare, initiating oral hypoglycemics between 2007 and 2009. MAIN MEASURES: We used group-based trajectory models to identify trajectories of oral hypoglycemics in the 12 months post-treatment initiation, using monthly proportion of days covered (PDC) as the adherence measure. Multivariable Cox proportional hazard models were used to examine the association between trajectories and time to first diabetes-related hospitalization/emergency department (ED) visits in the following year. We used the C-index to compare prediction performance between adherence trajectories and dichotomous cutpoints (annual PDC <80 vs. ≥80 %). RESULTS: The mean annual PDC was 0.58 (SD 0.32). Seven trajectories were identified: perfect adherers (9 % of the cohort), nearly perfect adherers (31.4 %), moderate adherers (21.0 %), low adherers (11.0 %), late discontinuers (6.8 %), early discontinuers (9.7 %), and non-adherers with only one fill (11.1 %). Compared to perfect adherers, trajectories of moderate adherers (HR = 1.48, 95 % CI 1.25, 1.75), low adherers (HR = 1.51, 95 % CI 1.25, 1.83), and non-adherers with only one fill (HR = 1.35, 95 % CI 1.09, 1.67) had greater risk of diabetes-related hospitalizations/ED visits. Predictive accuracy was improved using trajectories compared to dichotomized cutpoints (C-index = 0.714 vs. 0.652). CONCLUSIONS: Oral hypoglycemic treatment trajectories were highly variable in this large Medicaid cohort. Low and moderate adherers and those filling only one prescription had a modestly higher risk of hospitalizations/ED visits compared to perfect adherers. Trajectory models may be valuable in identifying specific non-adherence patterns for targeting interventions.

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“…[8][9][10] Consistent adherence to cardiovascular and/or antidiabetic medication therapy, on the other hand, is associated with better healthrelated outcomes. 11,12 Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence the dose titration is completed after discharge; or the brand is switched for financial reasons. However, careful optimization of medication complexity might be short lived when primary care providers (PCPs) are not informed about the background of the treatment modifications.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence

Stange

Kriston²,

von-Wolff³

et al. 2013

JMCP

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Relationship of Blood Pressure Control and Hospitalization Risk to Medication Adherence Among Patients With Hypertension in Taiwan

Abstract: Our observation study clearly indicates that lower medication adherence is associated with poor BP control and higher risk of CVD and all-cause hospitalization in hypertensive patients.

Cited by 73 publications

References 27 publications

Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications

Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence

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