School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Clin Ther. 2009 Oct;31(10):2170-7; discussion 2150-1. doi: 10.1016/j.clinthera.2009.10.004.
Although poor control of hypertension is a problem worldwide, most published studies of adherence to antihypertensive medications have involved only white subjects.
This study examined levels of and factors associated with short-term adherence to beta-blocker therapy among a representative sample of ethnic Chinese patients with hypertension from a large territory in Hong Kong.
Data for all hypertensive patients aged > or = 18 years who received a prescription for a beta-blocker at a visit to any public primary care clinic in the New Territory East cluster of Hong Kong and made at least 1 subsequent visit for a refill of this prescription between January 2004 and June 2007 were obtained from a validated clinical database generalizable to the Chinese population. The proportion of patients who were adherent to beta-blocker therapy was measured based on the medication possession ratio (MPR), calculated over 2 consecutive visits. Good adherence was defined as an MPR > or = 80%. Factors potentially associated with adherence to beta-blockers were investigated using multivariable logistic regression analysis, with adjustment for age, sex, payment status, service type, district of residence, visit type, and number of comorbidities.
Data were obtained for 15,918 eligible patients (62.2% female; mean age, 59.1 years). Of these patients, 81.3% were adherent to beta-blocker therapy. Factors associated with a greater likelihood of good adherence to beta-blocker therapy were age > or = 50 years (adjusted odds ratio [AOR], age 50-59 years = 1.53 [95% CI, 1.38-1.70]; AOR, age 60-69 years = 1.85 [95% CI, 1.64-2.10]; AOR, age > or = 70 years = 1.88 [95% CI, 1.66-2.12]; all, P < 0.001); fee paid versus fee waived (AOR = 1.16 [95% CI, 1.06-1.28]; P = 0.001); attendance at a family medicine specialist clinic (AOR = 1.30 [95% CI, 1.09-1.54]; P = 0.003); and follow-up visit versus new-patient visit (AOR = 2.67 [95% CI, 2.42-2.95]; P < 0.001).
Among these Chinese patients with hypertension, younger patients, those whose fees were waived, and those who were newly prescribed a beta-blocker had a greater likelihood of being nonadherent.
尽管全世界范围内高血压控制不佳都是一个问题，但大多数已发表的关于抗高血压药物依从性的研究仅涉及白人受试者。
本研究检测了来自香港新界一个代表性的华裔高血压患者群体短期服用β受体阻滞剂的依从性水平及其相关因素。
2004 年 1 月至 2007 年 6 月期间，从经验证的临床数据库中获取了所有在香港新界东群组的任何公立基层医疗诊所就诊且至少有一次后续配药的、年龄≥18 岁的高血压患者的处方数据，这些患者均接受了β受体阻滞剂的治疗。基于药物使用比例（MPR），对连续两次就诊的患者的β受体阻滞剂治疗依从性比例进行了测量，MPR 计算方法为两次就诊期间的用药天数与就诊总天数的比值。MPR＞80%被定义为依从性好。采用多变量逻辑回归分析，调整了年龄、性别、支付状态、服务类型、居住地区、就诊类型和共病数量等因素后，对可能与β受体阻滞剂依从性相关的因素进行了调查。
共纳入 15918 名符合条件的患者（62.2%为女性；平均年龄 59.1 岁）。其中，81.3%的患者对β受体阻滞剂治疗有较好的依从性。年龄≥50 岁（调整后的优势比[OR]，50-59 岁=1.53[95%可信区间（CI）：1.38-1.70]；60-69 岁=1.85[95%CI：1.64-2.10]；≥70 岁=1.88[95%CI：1.66-2.12]；均 P＜0.001）、自费而非免费（OR=1.16[95%CI：1.06-1.28]；P=0.001）、在家庭医学专科诊所就诊（OR=1.30[95%CI：1.09-1.54]；P=0.003）和随访就诊而非初诊就诊（OR=2.67[95%CI：2.42-2.95]；P＜0.001）的患者，β受体阻滞剂治疗的依从性更好。
在这些华裔高血压患者中，年轻患者、自费患者和新处方β受体阻滞剂的患者，其不依从的可能性更高。
