title: Impact of changes in pill appearance in the adherence to angiotensin receptor blockers and in the blood pressure levels: a retrospective cohort study.
abstract: To assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment.
  
  
  
  Retrospective cohort study of a random sample of consecutive patients collecting their medication.
  
  
  
  40 community pharmacies in Alicante (Southeast Spain).
  
  
  
  602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included.
  
  
  
  Prevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables.
  
  
  
  161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136-148) than in those who did not have a change (median BP 127 mm Hg; IQR 118-135; p<0.001).
  
  
  
  There was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.
authors.affiliation: Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Lumbreras
authors.affiliation: Department of Engineering, Area of Pharmacy and Pharmaceutical Technologies, Miguel Hernández University, Alicante, Spain.
authors.forename: E
authors.initials: E
authors.lastname: López-Pintor
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003157:Community Pharmacy Services / Q000706:statistics & numerical data; D004349:Drug Packaging; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013030:Spain; D013607:Tablets
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D013607:Tablets
keywords: adherence; antihypertensive treatment; appearance; community pharmacy