Antihypertensive Medication Nonadherence Research Articles

Antihypertensive medication nonadherence and target organ damage in children with chronic kidney disease.

Nonadherence is common in children with chronic kidney disease (CKD). This may contribute to inadequate blood pressure control and adverse outcomes. This study examined associations between antihypertensive medication nonadherence, ambulatory blood pressure monitoring (ABPM) parameters, kidney function, and cardiac structure among children with CKD. We performed secondary analyses of data from the CKD in Children (CKiD) study, including participants with treated hypertension who underwent ABPM, laboratory testing, and echocardiography biannually. Nonadherence was defined by self-report of any missed antihypertensive medication 7days prior to the study visit. Linear regression and mixed-effects models were used to assess the association of nonadherence with baseline and time-updated ABPM profiles, estimated glomerular filtration rate (eGFR), urine protein to creatinine ratio (UPCR), and left ventricular mass index (LVMI). Five-hundred and eight participants met inclusion criteria, followed for a median of 2.9years; 212 (42%) were female, with median age 13years (IQR 10-16), median baseline eGFR 49 (33-64) ml/min/1.73m2 and median UPCR 0.4 (0.1-1.0) g/g. Nonadherence occurred in 71 (14%) participants. Baseline nonadherence was not significantly associated with baseline 24-h ABPM parameters (for example, mean 24-h SBP [β - 0.1, 95% CI - 2.7, 2.5]), eGFR (β 1.0, 95% CI - 0.9, 1.2), UCPR (β 1.1, 95% CI - 0.8, 1.5), or LVMI (β 0.6, 95% CI - 1.6, 2.9). Similarly, there were no associations between baseline nonadherence and time-updated outcome measures. Self-reported antihypertensive medication nonadherence occurred in 1 in 7 children with CKD. We found no associations between nonadherence and kidney function or cardiac structure over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

Self-reported adherence and reasons for nonadherence among patients with low proportion of days covered for antihypertension medications.

BACKGROUND: Incorporation of pharmacy fill data into the electronic health record has enabled calculations of medication adherence, as measured by proportion of days covered (PDC), to be displayed to clinicians. Although PDC values help identify patients who may be nonadherent to their medications, it does not provide information on the reasons for medication-taking behaviors. OBJECTIVE: To characterize self-reported adherence status to antihypertensive medications among patients with low refill medication adherence. Our secondary objective was to identify the most common reasons for nonadherence and examine the patient sociodemographic characteristics associated with these barriers. METHODS: Participants were adult patients seen in primary care clinics of a large, urban health system and on antihypertensive therapy with a PDC of less than 80% based on 6-month linked electronic health record-pharmacy fill data. We administered a validated medication adherence screener and a survey assessing reasons for antihypertensive medication nonadherence. We used descriptive statistics to characterize these data and logistic and Poisson regression models to assess the relationship between sociodemographic characteristics and adherence barriers. RESULTS: The survey was completed by 242 patients (57% female; 61.2% White; 79.8% not Latino/a or Hispanic). Of these patients, 45% reported missing doses of their medications in the last 7 days. In addition, 48% endorsed having at least 1 barrier to adherence and 38.4% endorsed 2 or more barriers. The most common barriers were being busy and having difficulty remembering to take medications. Compared with White participants, Black participants (incident rate ratio = 2.49; 95% CI = 1.93-3.22) and participants of other races (incident rate ratio = 2.16; 95% CI = 1.62-2.89) experienced a greater number of barriers. CONCLUSIONS: Nearly half of patients with low PDC reported nonadherence in the prior week, suggesting PDC can be used as a screening tool. Augmenting PDC with brief self-report tools can provide insights into the reasons for nonadherence. DISCLOSURES: Dr Kharmats, Ms Martinez, Dr Belli, Ms Zhao, Dr Mann, Dr Schoenthaler, and Dr Blecker received grants from the National Institute of Health/National Heart, Lung, Blood Institute. Dr Voils holds a license by Duke University for the DOSE-Nonadherence measure and is a consultant for New York University Grossman School of Medicine. This research was supported by the NIH (R01HL156355). Dr Kharmats received a postdoctoral training grant from the National Institutes of Health (5T32HL129953-04). Dr Voils was supported by a Research Career Scientist award from the Health Services Research & Development Service of the Department of Veterans Affairs (RCS 14-443). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the United States Government.

Association between health-related quality of life and nonadherence to antihypertensive medication.

We aimed to examine the association between nonadherence to antihypertensive medications and Health-related quality of life. A cross-sectional survey was undertaken. This study was conducted using the data from the Korea National Health and Nutrition Examination Survey. A total of 6493 participants who diagnosed with hypertension, affected by hypertension at the time of survey, and took daily antihypertensive medications or never took this medication were included. Multiple logistic regression analysis was performed to determine the factors that influenced the patients' nonadherence to antihypertensive medications according to sex. Our results showed that anxiety/depression was positively associated with antihypertensive medication nonadherence, regardless of sex. According to sex, mobility was negatively associated with antihypertensive medication nonadherence in women. In men, living together was negatively related to antihypertensive medication nonadherence. This study showed the factors associated with antihypertensive medication nonadherence according to sex. HRQoL was associated with antihypertensive medication nonadherence.

Antihypertensive medication non-adherence and its associated factors among adult patients with uncontrolled hypertension in a primary care setting

Introduction: Medication nonadherence is a significant challenge in the management of patients with hypertension. This study aimed to assess antihypertensive medication nonadherence and its associated factors in a cohort of patients with uncontrolled hypertension. Material and Methods: A cross-sectional study was conducted among 225 adult patients with uncontrolled hypertension systematically selected from attendees of the general outpatient clinic of an academic tertiary hospital in Kano, Nigeria. A structured questionnaire was used to collect data on their sociodemographic, clinical, and follow-up appointment characteristics. An 8-item medication adherence scale was used to assess medication adherence. Results: There were 155 (68.9%) females. The participants' median age (interquartile range [IQR]) was 55 (45–63) years. Their median adherence score (IQR) was 4 (1–6) of 8, while 87.1% were non-adherent to antihypertensive medication. The duration of treatment (p = 0.009), current blood pressure (p = 0.006), and adherence to follow-up clinic appointments (p = 0.0004) were significantly associated with their median medication nonadherence scores. Conclusion: The prevalence of medication non-adherence in this population is high; however, patients who have been treated for more than 5 years, those with high blood pressure readings (Stage 2 hypertension), and those who were adherent to follow-up appointments had worse medication adherence scores than the other counterparts. These findings justify the need to extensively explore (especially those with long duration of treatment and Stage 2 blood pressure readings) and address the reasons for non-adherence to antihypertensive medication (which should include the identified associated factors), given that medication adherence is crucial in controlling hypertension and its consequences.

Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27Million Patients.

BackgroundNonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide.Methods and ResultsWe investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality.ConclusionsWhile high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity.RegistrationURL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.

3 WHY THEY DON'T TAKE THE PILL: A QUALITATIVE STUDY OF ANTIHYPERTENSIVE MEDICATION NONAHDERENCE IN EAST BORNEO PRIMARY HEALTH CARE

Background: Adherence to antihypertensive medication is one of the key drivers of optimal blood pressure control. We found nonadherence to antihypertensive medication in some patients in the Sempaja Primary Health Care. Objective: To determine the factors that influence the patient's nonadherence to antihypertensive medication. Method: Qualitative study with in-depth interview method. Inclusion criteria are aged >18 year old, diagnosed with hypertension for at least 1 year, nonadherence to antihypertensive medication based on medical record and MMAS-8 (Morisky 8—Item Medication Adherence Questionnaire). In-depth interview was recorded, transcribed, reflected, and identified by triangulation method. Result: We have 9 subjects (67% female, 33% male), age range of 35-35 years (22.2%), 46-55 years (33.3%), >55 years (44.4%). Educational state were elementary school (44.4%), junior high school (11.1%), senior high school (44.4%). All subjects were covered by national health insurance. All subjects had blood pressure >140/90 mmhg. The pattern of antihypertensive prescribed were single oral antihypertensive (33%) and combination oral antihypertensive (67%). The identified factors are patient factors (lack of knowledge, unaware attitude, negative stigma toward primary health care), drug factors (side effect and alternative local herbal alternative), environmental factors (busy to work, wrong information from family and neighbors), healthcare system factors (difficulty in transportation, unfriendly services, low quality of education and counseling, limited drug options). Conclusion: Many factors lead to antihypertensive medication nonadherence in primary health care. We need to systematically identify the causes, optimize education and counseling, optimize prolanis program, treated hypertension with an individual approach, and invite community leaders to participate in solving existing problem.

Predictors of medication nonadherence among hypertensive clients in a Ghanaian population: Application of the Hill-Bone and Perceived Barriers to Treatment Compliance Scale.

Background and AimNonadherence to antihypertensive medication impairs optimal blood pressure and is influenced by multiple interrelating factors. Knowing the complexity of medication nonadherence and its associated factors is essential for intervention strategies. This study evaluated the predictors of medication nonadherence among hypertensive clients in a Ghanaian population.MethodsThis was a hospital‐based cross‐sectional study conducted at the Hypertensive Clinic of the Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana. A self‐designed questionnaire, the Hill‐Bone Compliance to High Blood Pressure Therapy and Perceived Barriers to Treatment Compliance Scales, were used for data collection from 246 hypertensives. Data were analyzed using Statistical Package for Social Sciences, version 25.ResultsMedication nonadherence was observed among 8.5% of the study participants. In a multivariate regression model perceived noneffectiveness of medication (odds ratio [OR] = 1.76, 95% confidence interval [CI]: 1.34–2.31, p < 0.001) and barriers to alcohol and smoking cessation (OR = 2.83, 95% CI: 1.31–6.13, p = 0.008) were associated increased odds of antihypertensive medication nonadherence. Also, patients who do not know their total prescription (OR = 8.81, 95% CI: 2.28–34.0, p = 0.002) were more likely to be nonadherent to their antihypertensive medications. Moreover, clients who associate signs/symptoms of palpitations (OR = 5.82, 95% CI: 1.31–25.80, p = 0.021), poor sleep (OR = 3.92, 95% CI: 1.09–14.12, p = 0.036) and decreased sexual drive (OR = 4.74, 95% CI: 0.96–23.28, p = 0.055), were more likely to be nonadherent to antihypertensive medication.ConclusionIn conclusion, we observed a lower nonadherence rate among hypertensive clients in a Ghanaian population with correlates being medication‐related factors. Most importantly, perceived noneffectiveness of medication, barriers to smoking and alcohol cessation, palpitations, poor sleep, and decreased sexual drive significantly predicted lower adherence and could serve as indicators for high risk of nonadherence to antihypertensive medications.

Prevalence and predictors of medication nonadherence among hypertensive patients

Introduction: Hypertension is a chronic disease that needs to be treated adequately. Nonadherence to antihypertensive medicines can lead to coronary heart disease and stroke complications. The present study assessed the prevalence and predictors of medication nonadherence among hypertensive patients. Methodology: A cross-sectional study was conducted among hypertensive patients visiting the outdoor patient department of a tertiary care hospital in North India. Trained investigators interviewed the study participants after obtaining their written informed consent. A validated tool, namely the Brief Medication Questionnaire, was used to assess the medication nonadherence. Statistical analyses were performed using the Epi Info version for Windows. Results: A total of 400 hypertensive patients participated in the study. The mean age of study participants was 62.8 years (standard deviation = 11.0). Around half (55.0%) of the hypertensive patients suffered from comorbid disease conditions. The prevalence of antihypertensive medication nonadherence was 23.8%. The logistic regression model revealed that patients having a shorter duration of hypertension (odds ratio = 2.2 [1.2–3.9]) and those living in a joint family (odds ratio = 1.7 [1.1–2.8]) had higher medication nonadherence, as compared to their counterparts. Conclusion: Nearly one-fifth of the study participants were nonadherent to their antihypertension medication. There is a need for designing and implementing effective strategies by health-care providers for increasing antihypertensive medication adherence.

TCTAP A-047 Physician Preferences for Recommending Renal Denervation to Hypertensive Patients Is Influenced by Patients’ Antihypertensive Medication Nonadherence Due to Medication Side Effects

TCTAP A-047 Physician Preferences for Recommending Renal Denervation to Hypertensive Patients Is Influenced by Patients’ Antihypertensive Medication Nonadherence Due to Medication Side Effects

Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis.

Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.

Abstract 14545: Prevalence of Medication Non-Adherence via Therapeutic Drug Monitoring in Patients With Uncontrolled Hypertension Treated at a Safety Net Hospital

Background: Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM. Methods: We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health&amp; Hospital System (PHHS). Patients with BP of ≥130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry. Results: Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. Sixty two patients had insurance, while 15 had prescription financial assistance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p&gt;0.999). Conclusions: We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.

Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association.

The widespread treatment of hypertension and resultant improvement in blood pressure have been major contributors to the dramatic age-specific decline in heart disease and stroke. Despite this progress, a persistent gap remains between stated public health targets and achieved blood pressure control rates. Many factors may be important contributors to the gap between population hypertension control goals and currently observed control levels. Among them is the extent to which patients adhere to prescribed treatment. The goal of this scientific statement is to summarize the current state of knowledge of the contribution of medication nonadherence to the national prevalence of poor blood pressure control, methods for measuring medication adherence and their associated challenges, risk factors for antihypertensive medication nonadherence, and strategies for improving adherence to antihypertensive medications at both the individual and health system levels.

Abstract P133: Prevalence Of Medication Non-adherence Via Therapeutic Drug Monitoring In Patients With Uncontrolled Hypertension Treated At A Safety Net Hospital

Background: Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM. Methods: We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health&amp; Hospital System (PHHS). Patients with BP of 130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry. Results: Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. There was no difference in baseline characteristics between the two groups. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. 15 patients had prescription financial assistance, while 62 patients had medical insurance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p&gt;0.999). Conclusions: We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.

Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension.

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Herbal or Dietary Supplement Use and Hypertensive Medications: Does the Combination Relate to Medication Adherence and Blood Pressure Control?

Introduction: Medication nonadherence contributes to poor blood pressure control and increases cardiovascular disease risk in patients with hypertension. Identifying modifiable risk factors for low or nonadherence to antihypertensive medication is needed. Studies that have examined the relationship between herbal or dietary supplement (HDS) use and antihypertensive medication nonadherence provide inconsistent findings. Data from the National Health and Nutrition Examination Survey were used to examine the association between HDS use, current use of prescribed antihypertensive medication, and blood pressure status. Methods: The study sample included hypertensive adults (n = 5,478) who have been told by a health professional to take prescribed medication for their health condition. Respondents were classified as either HDS users or HDS nonusers. Depending on the kind of supplement used, HDS users were further divided into three mutually exclusive groups: hypertension HDS users, nonhypertension HDS users, and those who used both kinds of supplements. Supplements groupings were based on reports in the literature. Blood pressure status definition was based on Eighth Joint National Committee (JNC 8) recommendations. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were obtained from logistic models. Results: Overall HDS use prevalence was 62%. Current medication use did not significantly differ between patients reporting no HDS use and those reporting HDS use (aOR: 1.45; 95% CI: 0.78-2.69). No observable differences were found in current medication use between patients reporting no HDS use and those taking nonhypertension HDS or both kinds of supplements. Use of hypertension HDS was associated with improved blood pressure (aOR: 1.90; 95% CI: 1.07-3.36) compared with no HDS use. Conclusion: In a nationally representative U.S. sample, HDS use did not compromise current use of prescribed medication and was associated with improved blood pressure control. More research is needed to better understand why HDS use is associated with better blood pressure control.

Cost-Related Antihypertensive Medication Nonadherence: Action in the Time of COVID-19 and Beyond.

Cost-Related Antihypertensive Medication Nonadherence: Action in the Time of COVID-19 and Beyond.

Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults.

BackgroundPoor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence.MethodsA cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers.ResultsAdherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR = 0.77, 95% CI [0.38–0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18–0.97]), and those who believed in the effectiveness of their treatment (OR = 0.31, 95% CI [0.14–0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23–2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31–5.48]), married (OR=1.96, 95% CI [1.27–3.90]), widowed (OR=2.11, 95% CI [1.62–6.50]), obese patients (OR = 1.76, 95% CI [1.21–1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17–6.76]) were more likely to exhibit non-adherence.ConclusionOur study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.

Determining the Prevalence of and the Factors Associated with Antihypertensive Medication Non-Adherence in the Gaza Strip.

BackgroundThis study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip.MethodsA cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach.ResultsThe overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities.ConclusionThe high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.

Clinic Versus Ambulatory Blood Pressure in Resistant Hypertension: Impact of Antihypertensive Medication Nonadherence: A Post Hoc Analysis the DENERHTN Study.

Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP-day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP-day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8-17.7 mm Hg, P<0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP-day-SBP difference, 0.1 mm Hg; 95% CI, -3.3 to 3.5 mm Hg; P=0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP-day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP-day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.

Abstract 032: A Pilot Study of Antihypertensive Medication Adherence Trends by Sex and Drug Class

Background: Antihypertensive medication nonadherence is believed to be a prevalent issue but is very difficult to accurately assess. As a result, using a variety methods, nonadherence rates ranging from 3-86% have been suggested. To clarify this problem among hypertensive patients attending a CVD outpatient clinic, we utilized high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS) to assess antihypertensive medication adherence and identify trends by sex and drug class Methods: Plasma was obtained from patients with either drug-controlled or drug resistant hypertension (RHTN) and analyzed via HPLC-MS for antihypertensive drugs which were categorized by drug class as: beta blockers, aldosterone antagonists, thiazide diuretics, ACE inhibitor/ARBs, or calcium antagonists. Clinic blood pressure (BP) measurements, sex, and prescription regimens were extracted from patient medical records at or near the time of plasma collection. “Adherence” or “nonadherence” was determined by comparison of the patient’s prescribed drug regimen and the presence/absence of prescribed drug(s) in their plasma. Results: Among 76 patients (47 women, mean age 63 ± SD 10), and 53% (43 of 76) white. Overall, nonadherence was confirmed in 29% (22 of 76). RHTN was more frequently identified in women than men (55%, 26 of 47 vs 38% 11 of 29) and nonadherence was higher in women than men (34%, 16 of 47 vs 21%, 6 of 29). As expected, BP in those who were fully adherent to prescribed antihypertensive drugs was significantly lower than in those who were nonadherent with one or more medications (129/75 vs 145/83 mm Hg, p=0.0015). Overall, ACE inhibitors or ARBs were associated with the least nonadherence. Among women, nonadherence was highest for aldosterone antagonists, whereas among men, nonadherence was highest for thiazide diuretics. Nonadherence appeared among those with RHTN (38%, 14 of 37) and those with controlled HTN (21%, 8 of 39). Conclusion: We observed nonadherence was more frequent among older women in a cohort of HTN and RHTN patients based on HPLC-MS confirmed drug levels. Nonadherence was variable based on drug class but lowest with angiotensin II active agents, which, if validated, should be considered when optimizing antihypertensive prescribing.