澳大利亚老年人降压药物的长期持续使用和依从性。

Long-term persistence and adherence to blood pressure lowering agents among older Australians.

机构信息

Centre of Cardiovascular Research and Education in Therapeutics, Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Australia.

出版信息

Pharmacoepidemiol Drug Saf. 2019 Jun;28(6):788-795. doi: 10.1002/pds.4742. Epub 2019 Feb 19.

DOI:10.1002/pds.4742

PMID:30784140

Abstract

PURPOSE

Poor adherence and persistence to blood pressure lowering (BPL) agents leads to increased risk of morbidity and mortality. The aim of this study was to investigate the long-term adherence, persistence, and re-initiation of BPL agents among older Australians (aged ≥65 years).

METHODS

We utilised the Pharmaceutical Benefits Scheme data covering a 10% random sample of Australians. We identified 31 088 older Australians (mean age, 75.4 years; 56% females) with newly initiated BPL therapy from 2008 to 2016. Adherence was assessed using the proportion of days covered (PDC) at 6-month intervals. Discontinuation was defined as ≥90 days without BPL coverage. Cox regression was applied to compare the time till the first discontinuation of BPL agents across different BPL categories and among various subgroups.

RESULTS

Over a mean follow-up of 3.8 years, 40% to 70% of older Australians received a BPL agent discontinued it. The median time to discontinuation ranged from 159 to 373 days. Persistence with fixed dose combinations was the best (68%, 58%, and 41% at 6, 12, and 36 months respectively), followed by angiotensin II receptor blockers (69%, 58%, and 40%), beta-blockers (67%, 54%, and 36%), angiotensin converting enzyme inhibitors (62%, 51%, and 34%), calcium channel blockers (57%, 47%, and 31%), and diuretics (59%, 41%, and 23%). Among those who discontinued, 30% to 50% re-initiated, with median days to re-initiation ranging from 177 to 302. Only 21% to 42% of the study population maintained "good" adherence (PDC ≥ 0.8) to BPLs over 3 years.

CONCLUSION

Compliance to BPL agents is poor among older Australians. Interventions to enhance adherence and persistence to BPL agents are needed.

摘要

目的

降压药物（BPL）的依从性和持久性差会增加发病率和死亡率。本研究的目的是调查老年澳大利亚人（≥65 岁）中 BPL 药物的长期依从性、持久性和重新开始使用情况。

方法

我们利用了覆盖澳大利亚 10%随机样本的药品福利计划数据。我们确定了 31088 名 2008 年至 2016 年期间新开始 BPL 治疗的老年澳大利亚人（平均年龄 75.4 岁，56%为女性）。使用每 6 个月的比例天数覆盖（PDC）来评估依从性。停药定义为≥90 天没有 BPL 覆盖。Cox 回归用于比较不同 BPL 类别和不同亚组之间首次停药的时间。

结果

在平均 3.8 年的随访中，40%至 70%的老年澳大利亚人接受了 BPL 药物治疗，但其中 40%至 70%的人停药。停药的中位时间范围为 159 至 373 天。固定剂量联合治疗的持久性最好（6 个月、12 个月和 36 个月时分别为 68%、58%和 41%），其次是血管紧张素 II 受体阻滞剂（69%、58%和 40%）、β受体阻滞剂（67%、54%和 36%）、血管紧张素转换酶抑制剂（62%、51%和 34%）、钙通道阻滞剂（57%、47%和 31%）和利尿剂（59%、41%和 23%）。在停药的患者中，30%至 50%重新开始使用，重新开始的中位时间范围为 177 至 302 天。只有 21%至 42%的研究人群在 3 年内保持了对 BPL 的“良好”依从性（PDC≥0.8）。