Wong Martin C S, Tam Wilson W S, Wang Harry H X, Cheung Clement S K, Tong Ellen L H, Cheung N T, Leeder Stephen R, Griffiths Sian M
JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
Int J Cardiol. 2015 Mar 1;182:503-8. doi: 10.1016/j.ijcard.2014.12.058. Epub 2014 Dec 23.
Optimal adherence with antihypertensive medications is crucial to prevent hypertension-related complications. This study evaluated whether the duration of initial antihypertensive prescription is associated with better medication adherence in a large sample of Chinese hypertensive patients.
From a validated clinical database which consists of all patients in the public healthcare sector in Hong Kong, all patients on their first-ever antihypertensive agent from 2001 to 2005 (N=203,259) were included and followed-up for 12 months (and up to 5 years in separate analyses). The average age was 58.7 years (SD 17.3), and the overall rate of optimal adherence (as measured by having the Proportion of Days Covered≥0.80) was 32.4%. The proportion of patients whose initial prescriptions lasted for ≤6 days; 7-14 days; 15-28 days and ≥29 days was 23.7%, 24.3%, 15.1% and 37.0%, respectively. The corresponding proportion of optimal adherence was 18.1%, 20.1%, 31.0% and 50.3%. The binary logistic regression analysis showed that after controlling for age, sex, socioeconomic status, service type, drug class, and district of residence, those whose initial prescription was 7-14 days (adjusted odds ratio [AOR]=1.17, 95% C.I. 1.12-1.22); 15-28 days (AOR=1.90, 95% C.I. 1.82-1.99) and ≥29 days (AOR=4.13, 95% C.I. 3.96-4.31) were significantly more likely to be adherent than those who were prescribed for ≤6 days (all p<0.001). These findings remained significant in separate analyses where the period of follow-up was extended to 5 years.
Shorter duration of first antihypertensive prescriptions was associated with poorer medication adherence, and this practice should be avoided if possible.
最佳的抗高血压药物依从性对于预防高血压相关并发症至关重要。本研究评估了首次抗高血压处方的时长是否与大量中国高血压患者更好的药物依从性相关。
从一个经过验证的临床数据库（该数据库包含香港公共医疗部门的所有患者）中，纳入了2001年至2005年首次服用抗高血压药物的所有患者（N = 203,259），并随访12个月（在单独分析中随访长达5年）。平均年龄为58.7岁（标准差17.3），最佳依从率（以覆盖天数比例≥0.80衡量）为32.4%。初始处方持续时间≤6天、7 - 14天、15 - 28天和≥29天的患者比例分别为23.7%、24.3%、15.1%和37.0%。相应的最佳依从比例分别为18.1%、20.1%、31.0%和50.3%。二元逻辑回归分析显示，在控制了年龄、性别、社会经济地位、服务类型、药物类别和居住地区后，初始处方为7 - 14天（调整后的优势比[AOR]=1.17，95%置信区间1.12 - 1.22）、15 - 28天（AOR = 1.90，95%置信区间1.82 - 1.99）和≥29天（AOR = 4.13，95%置信区间3.96 - 4.31）的患者比处方≤6天的患者更有可能坚持服药（所有p < 0.001）。在将随访期延长至5年的单独分析中，这些结果仍然显著。
首次抗高血压处方的持续时间较短与较差的药物依从性相关，应尽可能避免这种做法。
