title: Predictors of adherence to concomitant antihypertensive and lipid-lowering medications in older adults: a retrospective, cohort study.
abstract: BACKGROUND
  Many older individuals have concomitant hypertension and dyslipidaemia--two conditions that, together with age, increase the risk of adverse cardiovascular events. Adherence to antihypertensive (AH) and lipid-lowering (LL) therapy is therefore particularly important in older patients with concomitant hypertension and dyslipidaemia.
  
  
  OBJECTIVE
  To determine patterns and predictors of adherence to concomitant AH and LL therapy among an older Medicare-eligible population.
  
  
  METHODS
  Enrolees (n=4052) aged>or=65 years who initiated treatment with both AH and LL therapy within a 90-day period were studied in this retrospective cohort study conducted in a US managed care organization. Adherence to AH and LL medications was measured as the proportion of days covered by any AH and/or LL medication in each 3-month interval, from the start of concomitant therapy for up to 36 months (mean follow-up 19.5 months). In each interval, patients were considered 'adherent' to AH and LL therapy if they had filled prescriptions sufficient to cover>or=80% of days with both medication classes. A multivariable regression model evaluated potential predictors of adherence to concomitant therapy, including patient demographics, clinical characteristics and health services use patterns at baseline.
  
  
  RESULTS
  The percentage of patients adherent to both AH and LL therapy declined rapidly, before stabilizing, with 40.5%, 32.7% and 32.9% adherent at 3, 6 and 12 months, respectively. At each timepoint, an additional 27.8-35.0% of patients were adherent to either AH or LL therapy, but not both. Adherence was on average greater to AH than LL therapy. After adjusting for age, sex and other potential predictors, patients were more likely to be adherent if AH/LL therapies were initiated closer together in time (adjusted odds ratio [AOR] 1.13 for 0-30 days vs 61-90 days, p=0.0563), had a history of cardiovascular disease (AOR 1.27, p=0.0004), took fewer additional medications (AOR 0.43 for six or more medications vs zero or one medication, p<0.0001) or had more outpatient physician visits in the prior year (AOR 1.26 for four to six visits vs zero to one visit, p<0.0027).
  
  
  CONCLUSIONS
  Adherence to concomitant AH and LL therapy among older adults is poor. Modifiable factors that may improve adherence in Medicare-eligible patients include initiating therapy concurrently and reducing patients' overall pill burden.
authors.affiliation: IMS Health, Falls Church, Virginia 22046, USA. rchapman@us.imshealth.com
authors.forename: Richard H
authors.initials: RH
authors.lastname: Chapman
authors.forename: Allison A
authors.initials: AA
authors.lastname: Petrilla
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Benner
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Simon S K
authors.initials: SS
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014481:United States; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents