Duration of initial antihypertensive prescription and medication adherence: A cohort study among 203, 259 newly diagnosed hypertensive patients. (1st March 2015)

• Record Type: Journal Article
• Authors: Wong, Martin C.S.; Tam, Wilson W.S.; Wang, Harry H.X.; Cheung, Clement S.K.; Tong, Ellen L.H.; Cheung, N.T.; Leeder, Stephen R.; Griffiths, Sian M.
• Is Part Of: International journal of cardiology. Volume 182(2015)
• Page Start: 503
• Page End: 508
• Publication Date: 2015-03-01
• Subjects: Duration -- Initial antihypertensive prescription -- Medication adherence -- Cohort study -- Chinese population; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2014.12.058
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Optimal adherence with antihypertensive medications is crucial to prevent hypertension-related complications. This study evaluated whether the duration of initial antihypertensive prescription is associated with better medication adherence in a large sample of Chinese hypertensive patients. Methods and results: From a validated clinical database which consists of all patients in the public healthcare sector in Hong Kong, all patients on their first-ever antihypertensive agent from 2001 to 2005 (N = 203, 259) were included and followed-up for 12 months (and up to 5 years in separate analyses). The average age was 58.7 years (SD 17.3), and the overall rate of optimal adherence (as measured by having the Proportion of Days Covered ≥ 0.80) was 32.4%. The proportion of patients whose initial prescriptions lasted for ≤ 6 days; 7–14 days; 15–28 days and ≥ 29 days was 23.7%, 24.3%, 15.1% and 37.0%, respectively. The corresponding proportion of optimal adherence was 18.1%, 20.1%, 31.0% and 50.3%. The binary logistic regression analysis showed that after controlling for age, sex, socioeconomic status, service type, drug class, and district of residence, those whose initial prescription was 7–14 days (adjusted odds ratio [AOR] = 1.17, 95% C.I. 1.12–1.22); 15–28 days (AOR = 1.90, 95% C.I. 1.82–1.99) and ≥ 29 days (AOR = 4.13, 95% C.I. 3.96–4.31) were significantly more likely to be adherent than those who were prescribed for ≤ 6 days (all p < 0.001). These findings remained significant in separate analyses where the period of follow-up was extended to 5 years. Conclusions: Shorter duration of first antihypertensive prescriptions was associated with poorer medication adherence, and this practice should be avoided if possible. Highlights: Duration of initial anti-HT prescription and medication adherence was evaluated. A large sample of Chinese patients were followed up to up to five years. Shorter duration of first anti-HT prescriptions related to poorer adherence. Longer duration of prescriptions might be better for medication-naïve patients.