title: Trends in Antihypertensive Medication Discontinuation and Low Adherence Among Medicare Beneficiaries Initiating Treatment From 2007 to 2012.
abstract: Low antihypertensive medication adherence is common. During recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days after initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days after initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41 135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable during the study period (21.0% in 2007 and 21.3% in 2012; P-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (P-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval, 0.83-0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries; however, rates of discontinuation and low adherence remain high.
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.). gtajeu@uab.edu.
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Tajeu
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Shia T
authors.initials: ST
authors.lastname: Kent
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Marie
authors.initials: M
authors.lastname: Krousel-Wood
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Adam P
authors.initials: AP
authors.lastname: Bress
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: From the Department of Epidemiology, University of Alabama at Birmingham (G.S.T., S.T.K., L.H., P.M.); Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K., D.S.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (M.K.-W.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.); Research Division, Ochsner Clinic Foundation, New Orleans, LA (M.K.-W.); and Departments of Population Health Sciences and Pharmacotherapy, University of Utah, Salt Lake City (A.P.B.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D055118:Medication Adherence / Q000208:ethnology; D020380:Needs Assessment; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents
keywords: cardiovascular disease; epidemiology; hypertension; medicare; medication adherence; risk factors; trends