title: Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries - United States, 2014.
abstract: BACKGROUND
  Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014.
  
  
  METHODS
  Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics.
  
  
  RESULTS
  Overall, 26.3% (4.9 million) of Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen. Nonadherence differed by multiple factors, including medication class (range: 16.9% for angiotensin II receptor blockers to 28.9% for diuretics); race-ethnicity (24.3% for non-Hispanic whites, 26.3% for Asian/Pacific Islanders, 33.8% for Hispanics, 35.7% for blacks, and 38.8% for American Indians/Alaska Natives); and state of residence (range 18.7% for North Dakota to 33.7% for the District of Columbia). Considerable county-level variation in nonadherence was found; the highest nonadherence tended to occur in the southern United States (U.S. Census region nonadherence = 28.9% [South], 26.7% [West], 24.1% [Northeast], and 22.8% [Midwest])
  More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ritchey
authors.forename: Anping
authors.initials: A
authors.lastname: Chang
authors.forename: Christopher
authors.initials: C
authors.lastname: Powers
authors.forename: Fleetwood
authors.initials: F
authors.lastname: Loustalot
authors.forename: Linda
authors.initials: L
authors.lastname: Schieb
authors.forename: Michelle
authors.initials: M
authors.lastname: Ketcham
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Durthaler
authors.forename: Yuling
authors.initials: Y
authors.lastname: Hong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D055118:Medication Adherence / Q000208:ethnology; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents