Adherence Level to Arterial Hypertension Treatment: A Cross-Sectional Patient Survey and Retrospective Analysis of the NHS Prescription Database.

Anna Gavrilova,Dace Bandere,Dins Šmits,Konstantīns Logviss,Inga Urtāne

doi:10.3390/healthcare9081085

Anna Gavrilova, Dace Bandere + Show 3 more

Open Access

https://doi.org/10.3390/healthcare9081085

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Journal: Healthcare	Publication Date: Aug 23, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Riga Stradiņš University

Abstract

One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors.

Highlights

High blood pressure (BP) is a serious medical conditions affecting 1.13 billion people worldwide according to the World Health Organization [1]
According to new concepts in guidelines for the management of arterial hypertension (AH), wider use of out-of-office BP measurement with ambulatory or home blood pressure monitoring is an option to confirm the diagnosis of AH in order to detect “white coat” and masked
AH, and to control the efficacy of the therapy [3]; it is important that the patient has a blood pressure monitor at home, but that they use it regularly

Summary

Introduction

High blood pressure (BP) is a serious medical conditions affecting 1.13 billion people worldwide according to the World Health Organization [1]. According to new concepts in guidelines for the management of AH, wider use of out-of-office BP measurement with ambulatory or home blood pressure monitoring is an option to confirm the diagnosis of AH in order to detect “white coat” (when a patient’s blood pressure readings are inaccurate due to certain environments) and masked. Non-adherence is a key reason why the majority of patients do not achieve optimal arterial blood pressure, resulting in an increased risk of cardiovascular complications [2,5]. Income, duration of AH, pharmacological treatments, and being a new user of a drug can influence patient adherence rates. Misdiagnoses such as “white coat” hypertension, comorbidity, high medication costs, and side effects may lead to non-adherence [6]. Intentional non-adherence is defined as conscious discontinuing, skipping, or changing of doses of medications, while unintentional non-adherence is associated with accidental forgetting or careless skipping of drug doses or not fully understanding the dosing regimen and patient information leaflet

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