Bhuiya N M Mahmudul Alam, Caballero Joshua, Young Henry N, Villa Zapata Lorenzo
Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia, USA.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70108. doi: 10.1111/jch.70108.
Understanding class-specific antihypertensive adherence is crucial for optimizing hypertension management. This retrospective cohort study analyzed adherence to antihypertensive medication among commercially insured adults (18-64 years) from 2018 to 2023 using Merative MarketScan data. Adherence was defined as the proportion of days covered (PDC) ≥ 80%. Among 2 770 855 hypertensive patients with single-pill therapy, the majority were older (43% aged 55-64 years) and predominantly male (53%). The South had the highest prevalence of hypertension (53%). Overall adherence improved significantly from 56.61% in 2018-2019 to 75.55% in 2022-2023 across all medication classes. Patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) combination therapies had the highest adherence rate (79.18%), while diuretics (67.58%) and "Other Drugs" (57.38%) had the lowest in 2022-2023. Logistic regression showed that younger patients (18-34 years) were significantly less adherent than older adults (OR = 0.434, 95% CI: 0.420-0.448). Males were more likely to adhere than females (OR = 1.142, 95% CI: 1.129-1.156). Regional variations were notable, with patients in the Northeast exhibiting 15% higher adherence than those in the West. Insurance types also influenced adherence, with managed care plan enrollees showing better adherence than those in fee-for-service plans (OR = 1.165, 95% CI: 1.151-1.179). Surprisingly, prescription refill monitoring reduced adherence, decreasing odds by 52% (OR = 0.482, 95% CI: 0.470-0.490). Monotherapy and combination therapy users differed significantly across all demographics (p < 0.0001). Higher comorbidity burden correlated with lower adherence, with diabetes being most prevalent among users of diuretics (12.88%), beta-blockers (12.8%), and other antihypertensives (26.01%). These findings highlight the multifaceted barriers to antihypertensive adherence and emphasize the need for targeted interventions that address medication-specific and patient-specific factors.
了解特定类别降压药物的依从性对于优化高血压管理至关重要。这项回顾性队列研究使用默克多市场扫描数据，分析了2018年至2023年商业保险成年人（18 - 64岁）中降压药物的依从性。依从性定义为覆盖天数比例（PDC）≥80%。在2770855名单一片剂治疗的高血压患者中，大多数患者年龄较大（43%为55 - 64岁），且男性居多（53%）。南部高血压患病率最高（53%）。总体依从性从2018 - 2019年的56.61%显著提高到2022 - 2023年的75.55%，涵盖所有药物类别。接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARB）联合治疗的患者依从率最高（79.18%），而利尿剂（67.58%）和“其他药物”（57.38%）在2022 - 2023年依从率最低。逻辑回归显示，年轻患者（18 - 34岁）的依从性显著低于老年成年人（OR = 0.434，95% CI：0.420 - 0.448）。男性比女性更易依从（OR = 1.142，95% CI：1.129 - 1.156）。地区差异显著，东北部患者的依从性比西部患者高15%。保险类型也影响依从性，参加管理式医疗计划的参保者比参加按服务收费计划的参保者依从性更好（OR = 1.165，95% CI：1.151 - 1.179）。令人惊讶的是，处方再配药监测降低了依从性，使几率降低了52%（OR = 0.482，95% CI：0.470 - 0.490）。单药治疗和联合治疗使用者在所有人口统计学特征上存在显著差异（p < 0.0001）。更高的合并症负担与更低的依从性相关，糖尿病在利尿剂使用者（12.88%）、β受体阻滞剂使用者（12.8%）和其他降压药使用者（26.01%）中最为普遍。这些发现突出了降压药物依从性的多方面障碍，并强调需要针对药物特异性和患者特异性因素进行有针对性的干预。
