Document Detail

Predictors of adherence to concomitant antihypertensive and lipid-lowering medications in older adults: a retrospective, cohort study.
MedLine Citation:
PMID:  18808213     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Many older individuals have concomitant hypertension and dyslipidaemia--two conditions that, together with age, increase the risk of adverse cardiovascular events. Adherence to antihypertensive (AH) and lipid-lowering (LL) therapy is therefore particularly important in older patients with concomitant hypertension and dyslipidaemia. OBJECTIVE: To determine patterns and predictors of adherence to concomitant AH and LL therapy among an older Medicare-eligible population. METHODS: Enrolees (n=4052) aged>or=65 years who initiated treatment with both AH and LL therapy within a 90-day period were studied in this retrospective cohort study conducted in a US managed care organization. Adherence to AH and LL medications was measured as the proportion of days covered by any AH and/or LL medication in each 3-month interval, from the start of concomitant therapy for up to 36 months (mean follow-up 19.5 months). In each interval, patients were considered 'adherent' to AH and LL therapy if they had filled prescriptions sufficient to cover>or=80% of days with both medication classes. A multivariable regression model evaluated potential predictors of adherence to concomitant therapy, including patient demographics, clinical characteristics and health services use patterns at baseline. RESULTS: The percentage of patients adherent to both AH and LL therapy declined rapidly, before stabilizing, with 40.5%, 32.7% and 32.9% adherent at 3, 6 and 12 months, respectively. At each timepoint, an additional 27.8-35.0% of patients were adherent to either AH or LL therapy, but not both. Adherence was on average greater to AH than LL therapy. After adjusting for age, sex and other potential predictors, patients were more likely to be adherent if AH/LL therapies were initiated closer together in time (adjusted odds ratio [AOR] 1.13 for 0-30 days vs 61-90 days, p=0.0563), had a history of cardiovascular disease (AOR 1.27, p=0.0004), took fewer additional medications (AOR 0.43 for six or more medications vs zero or one medication, p<0.0001) or had more outpatient physician visits in the prior year (AOR 1.26 for four to six visits vs zero to one visit, p<0.0027). CONCLUSION: Adherence to concomitant AH and LL therapy among older adults is poor. Modifiable factors that may improve adherence in Medicare-eligible patients include initiating therapy concurrently and reducing patients' overall pill burden.
Richard H Chapman; Allison A Petrilla; Joshua S Benner; J Sanford Schwartz; Simon S K Tang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Drugs & aging     Volume:  25     ISSN:  1170-229X     ISO Abbreviation:  Drugs Aging     Publication Date:  2008  
Date Detail:
Created Date:  2008-09-23     Completed Date:  2009-01-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102074     Medline TA:  Drugs Aging     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  885-92     Citation Subset:  IM    
IMS Health, Falls Church, Virginia 22046, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Ambulatory Care / statistics & numerical data
Antihypertensive Agents / therapeutic use*
Antilipemic Agents / therapeutic use*
Cohort Studies
Databases, Factual / statistics & numerical data
Drug Prescriptions / statistics & numerical data
Drug Therapy, Combination
Health Services for the Aged / statistics & numerical data*,  trends
Medicare / statistics & numerical data
Medication Adherence / statistics & numerical data*
Registries / statistics & numerical data
Retrospective Studies
Sex Factors
Time Factors
United States
Reg. No./Substance:
0/Antihypertensive Agents; 0/Antilipemic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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