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Drug adherence in treatment resistant and in controlled hypertension - Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Artikel i vetenskaplig tidskrift
Författare Lina Holmqvist
K. B. Bostrom
T. Kahan
Linus Schiöler
M. Qvarnstrom
B. Wettermark
P. Hjerpe
J. Hasselstrom
Karin Manhem
Publicerad i Pharmacoepidemiology and Drug Safety
Volym 27
Nummer/häfte 3
Sidor 315-321
ISSN 1053-8569
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för arbets-och miljömedicin
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 315-321
Språk en
Ämnesord drug adherence, hypertension, pharmacoepidemiology, primary care, treatment resistant hypertension, blood-pressure control, medication adherence, hypertensive patients, renal denervation, persistence, therapy, Public, Environmental & Occupational Health, Pharmacology & Pharmacy
Ämneskategorier Farmaceutisk farmakologi, Samhällsmedicin

Sammanfattning

Purpose To assess drug adherence in patients treated with 3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Methods Patients with hypertension, without cardiovascular comorbidity, aged >30years treated with 3 antihypertensive drug classes were followed for 2years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level80% were included. Results We found 5846 patients treated 3 antihypertensive drug classes, 3508 with TRH (blood pressure140/90), and 2338 with controlled blood pressure (<140/90mmHg). TRH patients were older (69.1 vs 65.8years, P<.0001) but had less diabetes (28.5 vs 31.7%, P<.009) compared with patients with controlled blood pressure. The proportion of patients with PDC80% declined with 11% during the first year in both groups. Having diabetes was associated with staying adherent at 1year (RR 0.82; 95% CI, 0.68-0.98) whilst being born outside Europe was associated with nonadherence at one and (RR 2.05; 95% CI, 1.49-2.82). ConclusionsPatients with multiple antihypertensive drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment.

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