A recent Morbidity and Mortality Weekly article has shown that over 1 in 4 hypertensive patients are non-adherent to their antihypertensive medication, and there is a high predisposition for this non-adherence among specific ethnic, age groups, states and geographic areas.
Hypertension is accounted as the leading risk factor for morbidity and mortality from cardiovascular diseases. Nearly 70% of US adults over the age 65 suffer from hypertension, only half of whom have their blood pressure under control. Persons who are adherent to their antihypertensive medications are 45% more likely to achieve blood pressure control and have up to a 38% decreased risk of having a cardiovascular event compared with persons who are non-adherent.
To achieve this hypertension control, a combination of medication, diet, and a specific lifestyle should be considered. Non-adherence to antihypertensive medications and non-compliance to a health care professional’s advice are the leading reasons for poor hypertension control among those diagnosed with hypertension. The reasons for this non-compliance are numerous, including, patient factors, healthcare professionals, and healthcare systems and their policies.
This Morbidity and Mortality Weekly journal study has focused on patient factors as one the leading non-adherence causes.
The data from a total number of 18.5 million U.S. hypertensive patients was analysed; this population was selected from the Medicare database. Non-adherence to medication was defined as a proportion of days a patient was covered with antihypertensives of <80%.
Among the study population who were prescribed antihypertensive medications, 4.9 million (26.3%) were non-adherent. This rate varied by race (24.3% white, 26.3% Asian/Pacific Islanders, 33.8% Hispanics, 35.7% African/ Americans, 38.8% American Indians/Alaska Natives).There was also an increased rate of non-adherence among low-income patients. The reason for initial antihypertensive medication prescription was also a contributory factor, as non-compliance was higher among those with end-stage renal disease.
Non-adherence was slightly higher among older age groups and with more than 1 antihypertensive medication prescription (27.2%) compared with a single class (23.2%). Non-adherence differed by medication class, ranging from 16.9% for angiotensin II receptor blockers (medications like Losartan, Valsartan) to 28.99% for diuretics (water pills).The greatest non-adherence tended to occur in the southern United States.
Regarding the different tendencies for non-adherence to antihypertensive medications, it can be concluded that certain focused interventions should be considered among specific patient populations to address this non-compliance to achieve a better blood pressure control.
Written By: Nima Makhdami, M.D.