Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease

Medientyp: E-Artikel
Titel: Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease
Beteiligte: Vupputuri, Suma; Muntner, Paul; Winkelmayer, Wolfgang C; Smith, David H; Nichols, Gregory A
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2012
Erschienen in: Circulation
Sprache: Englisch
DOI: 10.1161/circ.125.suppl_10.ap097
ISSN: 0009-7322; 1524-4539
Schlagwörter: Physiology (medical) ; Cardiology and Cardiovascular Medicine
Entstehung:
Anmerkungen:
Beschreibung: <jats:p> Inadequately controlled blood pressure (BP) is an important risk factor for the progression of chronic kidney disease (CKD). Few data are available on the association between adherence to antihypertensive medications and BP control among patients with CKD. We investigated the association of adherence to angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) with BP levels and BP control among CKD patients (n=3077) at Kaiser Permanente Georgia (an insurer and health care provider). Patients were required to have 2 outpatient diagnoses of CKD in 2008-2009, at least 2 fills of ACEi/ARBs, be 18+ years of age, with at least 1 year of continuous membership and prescription benefits prior to 01/01/08 and have no history of end-stage renal disease. We defined uncontrolled BP as systolic/diastolic of ≥140/90 mmHg and also ≥130/80 mmHg. As a measure of adherence we calculated the medication possession ratio (MPR): <jats:italic># of days medication supplied between the first and last prescription fills</jats:italic> <jats:italic>Duration from first to last prescription date + days supply from last prescription</jats:italic> The mean age of our sample was 64.1 ±11.9 years; 53.1% were female, and 57.6% African-American. In this sample, 22.6% and 8.9% had low and very low medication adherence, respectively; while 25.6% and 58.6% had systolic/diastolic BP of ≥140/90 and ≥130/80 mmHg, respectively. The mean BPs and odds ratios (ORs) for uncontrolled BP associated with level of adherence to antihypertensive medications are given in the <jats:xref ref-type="table">table</jats:xref> . In conclusion, among patients with CKD, poor medication adherence to antihypertensive medications was consistently associated with uncontrolled hypertension. Targeting interventions to improve medication adherence among patients with CKD may be an important strategy to improve BP control and, in turn, slow the progression of CKD. </jats:p> <jats:p> <jats:table-wrap orientation="portrait" position="anchor"> <jats:table> <jats:thead> <jats:tr> <jats:th align="left" colspan="1" rowspan="2" valign="top" /> <jats:th align="center" colspan="3" rowspan="1" valign="top">Medication Adherence</jats:th> <jats:th align="center" colspan="1" rowspan="2" valign="top">p-trend</jats:th> </jats:tr> <jats:tr> <jats:th align="center" colspan="1" rowspan="1" valign="top">High (MPR: ≥0.8) N=2109</jats:th> <jats:th align="center" colspan="1" rowspan="1" valign="top">Low (MPR: 0.5 to <0.8) N=694</jats:th> <jats:th align="center" colspan="1" rowspan="1" valign="top">Very low (MPR: <0.5) N=274</jats:th> </jats:tr> </jats:thead> <jats:tbody> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">Mean systolic BP, mmHg</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">131.3 (13.0)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">134.0 (14.7)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">137.5 (15.4)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top"><0.0001</jats:td> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">Mean diastolic BP, mmHg</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">72.5 (8.12)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">75.7 (9.21)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">78.7 (10.1)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top"><0.0001</jats:td> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">OR for SBP/DBP ≥140/90 mmHg</jats:td> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">Age, race, sex adjusted</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.0 (ref)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.40 (1.14, 1.73)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">2.30 (1.73, 3.06)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top"><0.0001</jats:td> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top"> Multivariate adjusted <jats:xref ref-type="table-fn">*</jats:xref> </jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.0 (ref)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.24 (0.97, 1.57)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.96 (1.40, 2.75)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top"><0.0001</jats:td> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">OR for SBP/DBP ≥130/80 mmHg</jats:td> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> <jats:td align="left" colspan="1" rowspan="1" valign="top" /> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top">Age, race, sex adjusted</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.0 (ref)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.21 (1.00, 1.46)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.81 (1.33, 2.45)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top"><0.0001</jats:td> </jats:tr> <jats:tr> <jats:td align="left" colspan="1" rowspan="1" valign="top"> Multivariate adjusted <jats:xref ref-type="table-fn">*</jats:xref> </jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.0 (ref)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.11 (0.89, 1.38)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">1.43 (1.01, 2.01)</jats:td> <jats:td align="center" colspan="1" rowspan="1" valign="top">0.04</jats:td> </jats:tr> </jats:tbody> </jats:table> <jats:table-wrap-foot> <jats:fn> <jats:label> <jats:sup>*</jats:sup> </jats:label> <jats:p>Adjusted for age, race, sex, socioeconomic status, co-morbidities, clinical measures, and number of medication classes.</jats:p> </jats:fn> </jats:table-wrap-foot> </jats:table-wrap> </jats:p>
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