Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel.
Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Clin Hypertens (Greenwich). 2019 Feb;21(2):243-248. doi: 10.1111/jch.13475. Epub 2019 Feb 7.
Good medication adherence is a key factor in chronic disease management. Poor adherence is associated with adverse outcomes and high costs. We aimed to explore adherence rates among oral antihypertensive medications. The study included members of the Central District of Clalit Health Services in Israel aged between 40 and 75 years, who were diagnosed with hypertension before 2012 and who filled at least one prescription per year during 2012-2014, for the following medications: hydrochlorothiazide, nifedipine, amlodipine, lercanidipine hydrochloride, atenolol, bisoprolol, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARBs), and statins. Purchase of at least nine monthly prescriptions during 2013 was considered as "good medication adherence." We compared systolic blood pressure and LDL levels, according to medication adherence, for each medication and cross-adherence rates between medications. The study included 31 530 subjects. The rates of good medication adherence varied widely among the medications investigated, ranging from 53% for statins and hydrochlorothiazide to 71% for amlodipine. Mean systolic BP and LDL levels were statistically significantly lower among persons with good, compared to lower adherence, for each of the medications investigated. Both advanced age and more chronic medications were associated with higher adherence rates for all medications tested. Poor adherence to any single medication was found to be associated with lower adherence to other medications. Different antihypertensive medications have different adherence rates. Since adherence to one medication is related to adherence to other medications, investing in medication adherence may be highly beneficial.
良好的药物依从性是慢性病管理的关键因素。药物依从性差与不良结局和高成本相关。我们旨在探讨口服降压药物的依从率。该研究纳入了以色列中央区克里利特卫生服务的成员，年龄在 40 至 75 岁之间，他们在 2012 年之前被诊断患有高血压，并在 2012-2014 年期间每年至少开一种处方，用于以下药物：氢氯噻嗪、硝苯地平、氨氯地平、盐酸乐卡地平、阿替洛尔、比索洛尔、血管紧张素转换酶抑制剂 (ACEI)、血管紧张素 II 受体拮抗剂 (ARB) 和他汀类药物。2013 年至少购买 9 个月的处方被认为是“良好的药物依从性”。我们根据药物依从性比较了每种药物的收缩压和 LDL 水平，以及药物之间的交叉依从率。该研究纳入了 31530 名受试者。在所研究的药物中，良好药物依从率差异很大，从他汀类药物和氢氯噻嗪的 53%到氨氯地平的 71%不等。与较低依从性相比，良好依从性的患者的平均收缩压和 LDL 水平显著降低。对于所有测试的药物，年龄较大和更多慢性药物与更高的依从率相关。任何一种药物的依从性差都与其他药物的依从性差相关。不同的降压药物具有不同的依从率。由于对一种药物的依从性与对其他药物的依从性相关，因此投资于药物依从性可能非常有益。
