title: Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan.
abstract: BACKGROUND
  Despite the efficacy of antihypertensive treatment in preventing cardiovascular complications, there are often problems with medication adherence in hypertensive patients. The objective of this study was to examine the medication adherence and its association with blood pressure (BP) control, cardiovascular disease (CVD) hospitalization, and all-cause hospitalization.
  
  
  METHODS
  We conducted a retrospective cohort observation of patients who were treated for hypertension from January 2005 to December 2006. Medical and pharmacy claims were obtained from Taiwan's National Health Insurance (NHI) database, whereas electronic records, including demographic characteristics and clinical information, were retrieved from a disease management program. To determine the degree of medication adherence, we calculated the proportion of days covered (PDC) by filled prescriptions. The associations of medication adherence with BP control, CVD hospitalization, and all-cause hospitalization were examined using multiple logistic regression models.
  
  
  RESULTS
  The study subjects comprised a total of 29,685 hypertensive patients. Of which, 40.1% of the patients had hypertension history of >5 years and 39.7% of patients had some comorbidity. In total, 85.5% of patients were categorized as adherent, with PDC >or=80; 60% of adherent patients had good BP control. Poor medication adherence was associated with poor BP control (odds ratio (OR) = 1.20, 1.13-1.29), CVD hospitalization (OR = 1.43, 1.14-1.81), and all-cause hospitalization (OR = 1.47, 1.21-1.78).
  
  
  CONCLUSIONS
  Our observation study clearly indicates that lower medication adherence is associated with poor BP control and higher risk of CVD and all-cause hospitalization in hypertensive patients.
authors.affiliation: Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Pin-Hsuan
authors.initials: PH
authors.lastname: Wu
authors.forename: Chuh-Yuh
authors.initials: CY
authors.lastname: Yang
authors.forename: Zhi-Lian
authors.initials: ZL
authors.lastname: Yao
authors.forename: Wei-Zhan
authors.initials: WZ
authors.lastname: Lin
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Wu
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents