Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo City, Tokyo, Japan.
Department of Health Policy and Management, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan.
Hypertens Res. 2020 Jul;43(7):705-714. doi: 10.1038/s41440-020-0440-2. Epub 2020 Apr 20.
Nonadherence to antihypertensive drugs is a primary reason for suboptimal clinical outcomes among hypertensive patients. We assessed adherence to newly initiated antihypertensive medications in non-elderly Japanese patients and examined which patient and facility characteristics were associated with low adherence. We selected new oral antihypertensive drug users, aged 30-74 years, between 2014 and 2016 from a large administrative claims database. We measured adherence as the proportion of days covered (PDC) during a 1-year follow-up and divided patients into three groups of low (PDC < 40%), intermediate (PDC ≥ 40% to <80%), and high (PDC ≥ 80%) adherence. Factors associated with low adherence were assessed by logistic regression analysis with generalized estimating equations. Among 31,592 patients (mean age, 51.7 years; 41.2% female), the median 1-year PDC was 88.5% (IQR: 41.9-98.1%). In total, 59.2%, 16.6%, and 24.2% of patients were categorized as having high, intermediate, and low adherence, respectively. Female sex (odds ratio [OR] 1.15, 95% confidential interval [95% CI] 1.08-1.22), younger age, and the initiation of angiotensin-converting enzyme inhibitors (OR 1.37, 95% CI 1.12-1.66), beta-blockers and thiazide diuretics (OR 4.82, 95% CI 4.34-5.36 and OR 3.91, 95% CI 2.79-5.46, respectively; compared with angiotensin II receptor blockers) were associated with low adherence. Patients initiating antihypertensives at larger hospitals (≥200 beds) were more likely to be adherent. While adherence to antihypertensive drugs in non-elderly Japanese patients was relatively high compared with that reported in previous studies in Western countries, patients with intermediate-low adherence may benefit from targeted interventions.
抗高血压药物治疗不依从是高血压患者临床结局不理想的主要原因。我们评估了非老年日本患者新起始抗高血压药物治疗的依从性，并探讨了哪些患者和医疗机构特征与低依从性相关。我们从一个大型行政索赔数据库中选择了 2014 年至 2016 年新开始使用口服抗高血压药物的年龄在 30-74 岁的患者。我们将 1 年随访期间的用药天数比例（PDC）作为依从性的衡量标准，并将患者分为低（PDC＜40%）、中（PDC≥40%且＜80%）和高（PDC≥80%）依从性三组。采用广义估计方程的逻辑回归分析评估与低依从性相关的因素。在 31592 例患者（平均年龄 51.7 岁，41.2%为女性）中，中位 1 年 PDC 为 88.5%（IQR：41.9-98.1%）。总共有 59.2%、16.6%和 24.2%的患者分别归类为高、中、低依从性。女性（比值比 [OR] 1.15，95%置信区间 [95%CI] 1.08-1.22）、年龄较小、起始使用血管紧张素转换酶抑制剂（OR 1.37，95%CI 1.12-1.66）、β受体阻滞剂和噻嗪类利尿剂（OR 4.82，95%CI 4.34-5.36 和 OR 3.91，95%CI 2.79-5.46，与血管紧张素Ⅱ受体阻滞剂相比）与低依从性相关。在床位较多（≥200 张）的医院起始抗高血压药物治疗的患者更有可能依从。与以前在西方国家的研究相比，非老年日本患者的抗高血压药物治疗依从性相对较高，但中低依从性患者可能受益于有针对性的干预措施。
