Levin Jennifer B, Moore David J, Briggs Farren, Rahman Mahboob, Montoya Jessica, Depp Colin, Einstadter Douglas, Stange Kurt C, Weise Celeste, Maniglia Taylor, Barigye Richard, Howard Griggs Gracie, Adeniyi Clara, Yala Joy, Sajatovic Martha
Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Psychiatry, University of California San Diego, San Diego CA, USA.
Int J Psychiatry Med. 2025 Mar;60(2):203-220. doi: 10.1177/00912174241281984. Epub 2024 Sep 14.
Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This study examined the association between adherence to antihypertensive, adherence to BD medications, and clinical symptoms in patients with BD and comorbid hypertension (HTN). Participants were involved in an ongoing clinical trial.
Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pill bottle that captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over one week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms.
A total of 83 participants with BD and HTN were included. Adherence to BD medications and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than participants self-reported for antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline, whereas antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline.
Adherence levels fluctuated over time and differed based on measurement method in participants with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to a change in self-reported adherence. BD symptom severity may interfere with medication adherence in patients with BD and should be considered in treatment planning.
双相情感障碍（BD）患者的药物依从性欠佳、身患疾病以及过早死亡的发生率较高，主要原因是心血管疾病。本研究调查了BD合并高血压（HTN）患者的抗高血压药物依从性、BD药物依从性与临床症状之间的关联。参与者参与了一项正在进行的临床试验。
纳入标准为BD诊断、接受抗高血压治疗、存在依从性挑战以及HTN控制不佳。通过使用片剂常规问卷进行自我报告以及使用可记录开盖情况的电子药瓶eCAP来测量依从性。根据一周内的12次读数计算平均收缩压（SBP）。采用蒙哥马利-艾斯伯格抑郁评定量表（MADRS）和简明精神病评定量表（BPRS）评估BD症状。
共纳入83例BD合并HTN患者。BD药物依从性与抗高血压药物依从性呈正相关。与参与者自我报告的抗高血压药物依从性相比，eCAP记录的漏服剂量更多。BD药物依从性在基线时与BPRS呈正相关，而抗高血压药物依从性在筛查时与SBP呈负相关。从筛查到基线，抗高血压药物依从性有所改善，SBP有所下降。
BD合并HTN患者的依从性水平随时间波动，且因测量方法而异。自我报告的BD依从性与整体精神症状呈正相关，抗高血压药物依从性与更好的SBP控制相关。对药物和血压进行监测导致了自我报告的依从性发生变化。BD症状的严重程度可能会干扰BD患者的药物依从性，在治疗计划中应予以考虑。
