Abstract
Adherence to antihypertensive medication is a critical factor to control blood pressure and prevent complications. However, cognitive impairment can negatively affect medication adherence. In this study, we investigated the association between cognitive function and antihypertensive medication adherence among elderly hypertensive patients using the Korean National Health Insurance Service National Sample Cohort Data of the Elderly Cohort. The study included 20,071 elderly hypertensive patients and the prevalence of poor medication adherence to antihypertensive medications was 16.4%. A multivariate logistic regression analysis showed that lower cognitive function was associated with poor medication adherence (adjusted odds ratio 0.980, 95% confidence interval 0.961–0.999). Additionally, high income levels, living in metropolitan areas, and comorbidities (such as stroke, coronary heart disease, diabetes, and dyslipidemia) were positively associated with medication adherence, while patients diagnosed with cancers showed poor medication adherence. Our study demonstrated that cognitive impairment is a possible risk factor for poor antihypertensive medication adherence, even in patients without dementia. Thus, clinicians involved with geriatric care should monitor patients’ cognitive function and medication adherence. And if a patient shows cognitive impairment, clinicians need to educate patients and caregivers about the importance of proper adherence, and consider proper interventions to optimize the cognitive function of elderly patients.
Highlights
Patients with hypertension need life-long treatment with antihypertensive medications to prevent cardiovascular diseases (CVD)[1,2]
We found that 20,848 elderly patients had been prescribed antihypertensive medication at least twice in the year of the National Screening Program for Transitional Ages (NSPTA)
We found that results obtained from screening tests for depression and cognitive function were not statistically different between the two groups (Table 1)
Summary
Patients with hypertension need life-long treatment with antihypertensive medications to prevent cardiovascular diseases (CVD)[1,2]. Poor medication adherence is commonly observed in hypertensive patients. Measurements of medication adherence in these studies were mostly based on monitoring pill counts in patients[14,15,16], or via self-reports obtained from patients or caregivers[17,18]. This could have produced biased results due to patient awareness of being monitored. We designed a retrospective cohort study using a national administrative database in order to investigate the association between cognitive function and antihypertensive medication adherence among elderly hypertensive patients without dementia in Korea. We hypothesized that the use of routinely collected prescription data would minimize the bias linked to the direct monitoring of adherence, and would yield more representative results than previous studies
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