title: Disparities in adherence to and persistence with antihypertensive regimens: an exploratory analysis from a community-based provider network.
abstract: Despite the availability of effective antihypertensive therapies, adherence to and persistence with treatment is suboptimal. As such, there is a need to better understand factors associated with adherence and persistence, such as race/ethnicity. In a retrospective, exploratory analysis of 51,772 hypertensive adult subjects identified in the electronic medical record, we examined medication possession ratio and proportion of days covered as proxies for adherence and persistence, respectively. Logistic regression analyses were performed to assess the role of race/ethnicity in adherence to and persistence with antihypertensive treatments. Relative to white subjects, Asian American/Pacific Islander, black, Hispanic, and "other" subjects were significantly less likely to be adherent to and persistent with their antihypertensive regimens. Black and Hispanic subjects had the lowest odds of adherence (0.46, 95% CI: 0.43-0.49 and 0.58, 95% CI: 0.54-0.62, respectively) and persistence (0.70, 95% CI: 0.65-0.75 and 0.70, 95% CI: 0.66-0.74, respectively) relative to white subjects. Other factors significantly associated with both lower adherence and persistence included younger age and lower chronic disease score. Disparities were found with regard to adherence to and persistence with antihypertensive regimens. Future studies should address these disparities by designing interventions to improve medication-taking behavior in high-risk populations.
authors.affiliation: Clinical Outcomes Research Group, Clinical Integration, Sutter Health Support Services, Sacramento, CA 95833, USA. ishisad@sutterhealth.org
authors.forename: Denis Y
authors.initials: DY
authors.lastname: Ishisaka
authors.forename: Trevor
authors.initials: T
authors.lastname: Jukes
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Romanelli
authors.forename: Ken S
authors.initials: KS
authors.lastname: Wong
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Schiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D019058:Community Networks; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents