Within 6 months, 1 in 3 patients
fail
to take cardiovascular medications
Newswise Therapy
that includes medications to reduce high blood pressure and to lower
lipid levels can reduce risk for heart disease, but within six
months, more than a third of patients fail to take one or both
medications as prescribed, according to a study in the May 23 issue
of Archives of Internal Medicine, one of the JAMA/Archives
journals.
Patients with both high blood pressure and dyslipidemia (high lipid
levels), are at substantially greater risk of coronary heart disease
(CHD) events, such as heart attack, than those with either condition
alone, according to background information in the article. The
current study was designed to study how well patients with both
conditions adhere to a drug regimen including both anti-hypertensive
(AH, blood pressure lowering) and lipid-lowering (LL) medications.
Richard H. Chapman,
Ph.D., of ValueMedics Research, L.L.C., Arlington, Va., and
colleagues examined the database from a managed care organization to
identify patients who had been prescribed both anti-hypertensive and
lipid-lowering medications within a period of 90 days between
January 1, 1997, and January 30, 2001. Adherence to concomitant
therapy (taking both medications) was established at three, six and
12 months following treatment start on the basis of prescriptions
filled. Patients were considered to be taking their drugs as
prescribed if they had filled prescriptions sufficient to cover at
least 80 percent of days of both classes of medications.
A total of 8,406
patients were followed for an average of 12.9 months. The percentage
of patients adhering to both anti-hypertensive and lipid-lowering
declined sharply over the course of the study, with 44.7 percent
maintaining their treatment regimen at three months, 35.9 percent at
six months and 35.8 percent at twelve months. At each time interval,
an additional 25.3 to 29.6 percent were taking one, but not both,
drugs as prescribed.
The strongest
predictor of taking both medications as prescribed was the number of
other prescriptions the patient was taking in the year before
treatment was initiated, the researchers found. As the number of
other prescribed medications decreased, the likelihood of adherence
to concomitant anti-hypertensive and lipid-lowering therapy
increased. The second strongest predictor of adherence was age. The
third strongest predictor was the time between the initiations of
the two treatments. Patients who started these regimens on the same
day or within one month of each other were 34 percent more likely to
be adherent with both medications during the three-year study
period, compared with patients who initiated therapy two to three
months apart. Women were less likely to be adherent than men.
physicians may
be able to improve medication adherence substantially by reducing
the number of concomitant medications and by initiating AH and LL
medications together or close in time, the authors conclude. Any
improvement in adherence with concomitant AH and LL medications is
likely to be associated with substantial public health care
benefits.