From the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T., M.T.H.).
HealthCore, Wilmington, DE (S.T.K.).
Hypertension. 2019 Jul;74(1):35-46. doi: 10.1161/HYPERTENSIONAHA.118.12495. Epub 2019 May 28.
Previous evidence suggests modest improvements in antihypertensive medication adherence occurred from 2007 to 2012 among US adults ≥65 years of age. Whether adherence improved over time among adults <65 years of age is unknown. We assessed trends in antihypertensive medication nonpersistence and low adherence among 379 658 commercially insured adults <65 years of age initiating treatment in 2007-2014 using MarketScan claims. Nonpersistence was defined as having no days of medication available to take during the final 90 days of the 365 days following initiation. Among beneficiaries who were persistent to treatment, low adherence was defined by having antihypertensive medication available to take for <80% of the days in the 365 days following initiation (ie, proportion of days covered <80%). In 2007 and 2014, 23.3% and 23.5% of patients were nonpersistent to treatment, respectively, and 42.3% and 40.2% had low adherence, respectively. The relative risks for nonpersistence and low adherence were lower among beneficiaries initiating treatment with an angiotensin-converting enzyme inhibitor (0.95; 95% CI, 0.94-0.97 and 0.97; 95% CI, 0.96-0.98, respectively), angiotensin receptor blocker (0.86; 95% CI, 0.85-0.88 and 0.99; 95% CI, 0.97-1.00, respectively), or multiclass regimen (0.82; 95% CI, 0.80-0.84 and 0.88; 95% CI, 0.86-0.89, respectively), prescribed 90-day versus 30-day prescriptions (0.67; 95% CI, 0.66-0.68 and 0.70; 95% CI, 0.69-0.71, respectively), or who received medications by mail versus at the pharmacy (0.93; 95% CI, 0.90-0.95 and 0.90; 95% CI, 0.88-0.92, respectively). In conclusion, several modifiable factors were associated with lower rates of both antihypertensive medication nonpersistence and low adherence among adults <65 years of age initiating treatment in 2007-2014.
先前的证据表明，2007 年至 2012 年间，美国 65 岁及以上成年人的降压药物治疗依从性略有改善。65 岁以下成年人的依从性是否随时间而改善尚不清楚。我们使用 MarketScan 理赔数据评估了 2007 年至 2014 年期间 379658 名接受治疗的 65 岁以下商业保险成年人的降压药物不持续和低依从性趋势。无药可用的天数定义为在起始后 365 天的最后 90 天内没有可用的药物。在对治疗持续的受益人中，低依从性定义为在起始后 365 天内，有降压药物可用的天数<80%（即覆盖天数比例<80%）。2007 年和 2014 年，分别有 23.3%和 23.5%的患者对治疗不持续，分别有 42.3%和 40.2%的患者低依从性。起始时使用血管紧张素转换酶抑制剂（0.95；95%CI，0.94-0.97 和 0.97；95%CI，0.96-0.98）、血管紧张素受体阻滞剂（0.86；95%CI，0.85-0.88 和 0.99；95%CI，0.97-1.00）或多类药物治疗方案（0.82；95%CI，0.80-0.84 和 0.88；95%CI，0.86-0.89）的患者，起始时开具 90 天处方而非 30 天处方（0.67；95%CI，0.66-0.68 和 0.70；95%CI，0.69-0.71）或通过邮件而非药房接收药物（0.93；95%CI，0.90-0.95 和 0.90；95%CI，0.88-0.92）的患者，其药物不持续和低依从性的发生率较低。总之，2007 年至 2014 年间开始治疗的 65 岁以下成年人中，有几个可改变的因素与降压药物治疗不持续和低依从性的发生率降低有关。
