Atlanta—With cardiovascular disease the leading cause of death in the United States, hypertension is a primary risk factor that affects about 70% of adults 65 or older, according to a new report.
Yet, only about half of patients with high blood pressure have it under control, defined as below 140/90 mm Hg, according to the article released early by the Morbidity & Mortality Weekly Report.
One of the key reasons, according to researchers from the CDC, is nonadherence. In this study of Medicare Part D beneficiaries, 26.3%, representing 4.9 million patients, failed to take their blood pressure medication as prescribed.
“Although multiple factors contribute to the high proportion of uncontrolled blood pressure among persons in this age group, persons who are adherent to their antihypertensives are 45% more likely to achieve blood pressure control and have up to a 38% decreased risk for having a cardiovascular event compared with persons who are nonadherent,” study authors point out.
Demographics and geographic location made a difference in how likely patients were to follow medication instructions. The CDC researchers found that 24.3% of whites, 26.3% of Asian/Pacific Islanders, 33.8% of Hispanics, 35.7% of blacks, and 38.8% of American Indians or Alaska Natives were classified as being nonadherent.
The highest rates of nonadherence tended to occur in the southern United States, they note, adding,
“Although still suboptimal, if the average nonadherence rate of 18.9% among Medicare Part D beneficiary populations in the three states with the lowest nonadherence rates (North Dakota, Wisconsin, and Minnesota) were to be achieved in all states, the national nonadherence rate would decrease by about one third, and 1.4 million more beneficiaries would be taking their anti-hypertensives as directed.”
Socioeconomic status classifications also were a factor, according to the report, with 32.1% of patients with a low-income subsidy being classified as nonadherent, compared with 25.4% of patients with no subsidy.
“For older adults, who are often taking multiple chronic disease medications, including 72% of beneficiaries in this study taking two or more antihypertensives, an important factor in improving adherence is simplification of the antihypertensive regimen,” the researchers suggest.
The CDC recommends those strategies could include:
• Decreasing pill count through the use of fixed-dose combination medications, which were underused among most beneficiary groups in this study;
• Limiting the number of pharmacy visits needed by increasing the days’ supply per fill (e.g., prescribing 90-day vs. 30-day allotments), which had wide variability among beneficiary groups,
• Synchronizing fills for all medication, and
• Using reminder devices and technology aids that encourage patients to follow their recommended medication schedule.
The article also endorses a team approach—including physicians and physician assistants, nurses and nurse practitioners, pharmacists, and community health workers—to ensure patients’ medication regimens and adherence are regularly assessed and their blood pressure controlled.
“Coordinated care might help overcome the finding of increased nonadherence when patients have more prescribers managing their antihypertensive regimens,” study authors conclude.
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