Kurdi Amanj I, Chen Li-Chia, Elliott Rachel A
aStrathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow bDivision of Pharmacy and Optometry cDivision of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester dDivision for Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK.
J Hypertens. 2017 Sep;35(9):1881-1890. doi: 10.1097/HJH.0000000000001382.
To explore factors associated with adherence to antihypertensive drugs overall (therapy adherence) and to particular classes (class adherence) in hypertensive patients.
The current retrospective cohort study included adults with primary hypertension identified in the UK Clinical Practice Research Datalink from April 2006 to March 2013. Individuals were followed from the date of first-ever antihypertensive drug class (class adherence) prescribed and from the date of the first-ever antihypertensive drug (therapy adherence) issued to the earliest of study end, patient leaving the database, or death. Prescribing episodes (time from a drug class being first prescribed to the end of follow-up time) of six antihypertensive drug classes were recorded. Proportion of days covered (PDC) was used to estimate therapeutic adherence for a patient's antihypertensive drugs therapy during follow-up period and class adherence of a specific antihypertensive class in each episode, respectively. Generalized linear modelling was used to examine factors associated with PDC.
Median therapy and class PDC were 93.9 and 98.3% in the 176 835 patients and 371 605 prescribing episodes; 20 and 38.4% of the patients and episodes had PDC less than 80%, respectively. Higher therapy and class PDC was associated with increasing age, using renin angiotensin drugs, and being preexisting patient and user of antihypertensive drugs. Higher deprivation, multiple comorbidities, and switching of antihypertensive drugs were associated with lower PDC.
Several patient factors were confirmed as determinant of adherence to antihypertensive drug classes and therapy; hence, they can assist in identifying patients at risks of nonadherence, thus targeting them for adherence improving interventions.
探讨高血压患者中与总体抗高血压药物依从性（治疗依从性）及特定药物类别依从性（类别依从性）相关的因素。
当前这项回顾性队列研究纳入了2006年4月至2013年3月在英国临床实践研究数据链中识别出的原发性高血压成人患者。从首次开具抗高血压药物类别（类别依从性）的日期以及首次开具抗高血压药物（治疗依从性）的日期开始对个体进行随访，直至最早出现研究结束、患者退出数据库或死亡。记录了六种抗高血压药物类别的处方疗程（从首次开具药物类别到随访结束的时间）。采用覆盖天数比例（PDC）分别估算患者在随访期间抗高血压药物治疗的治疗依从性以及每个疗程中特定抗高血压类别的类别依从性。使用广义线性模型来检查与PDC相关的因素。
在176835例患者和371605个处方疗程中，治疗和类别PDC的中位数分别为93.9%和98.3%；分别有20%的患者和38.4%的疗程PDC低于80%。较高的治疗和类别PDC与年龄增加、使用肾素血管紧张素药物、既往为抗高血压药物患者及使用者相关。较高的贫困程度、多种合并症以及抗高血压药物的更换与较低的PDC相关。
证实了几个患者因素是抗高血压药物类别及治疗依从性的决定因素；因此，它们有助于识别依从性差风险的患者，从而针对他们进行改善依从性的干预。
