title: Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults.
abstract: OBJECTIVE
  To determine whether sociodemographic, clinical, healthcare system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores in older men and women.
  
  
  METHODS
  Cross-sectional analysis of baseline data.
  
  
  METHODS
  Cohort Study of Medication Adherence in Older Adults (N = 2,194).
  
  
  METHODS
  Low antihypertensive medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale. Information on risk factors for low adherence was collected using telephone surveys and administrative databases.
  
  
  RESULTS
  The prevalence of low medication adherence scores did not differ according to sex (women, 15.0%; men 13.1%; P = .21). In sex-specific multivariable models, having problems with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores in men and women. Factors associated with low adherence scores in men but not women were poor sexual functioning (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.31-3.16 for men and OR = 1.28, 95% CI = 0.90-1.82 for women), and body mass index of 25.0 kg/m(2) or more (OR = 3.23, 95% CI = 1.59-6.59 for men; OR = 1.23, 95% CI = 0.82-1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75, 95% CI = 1.16-2.65 for women; OR = 1.16, 95% CI = 0.57-2.34 for men) and depressive symptoms (OR = 2.29, 95% CI = 1.55-3.38 for women; OR = 0.93, 95% CI = 0.48-1.80 for men).
  
  
  CONCLUSIONS
  Factors associated with low antihypertensive medication adherence scores differed according to sex. Interventions designed to improve adherence in older adults should be customized to account for the sex of the target population.
authors.affiliation: Center for Health Research, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holt
authors.forename: Cara
authors.initials: C
authors.lastname: Joyce
authors.forename: Adriana
authors.initials: A
authors.lastname: Dornelles
authors.forename: Donald
authors.initials: D
authors.lastname: Morisky
authors.forename: Larry S
authors.initials: LS
authors.lastname: Webber
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Marie
authors.initials: M
authors.lastname: Krousel-Wood
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D057566:Self Report; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents