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Bob Schwadron 212-468-3616
DRUG CHOICE INCREASES COMPLIANCE AMONG ELDERLY HYPERTENSIVES
NEW YORK, NY -- Newer antihypertensive medications are more effective
in controlling blood pressure of elderly people, especially those
with heart disease who see their doctors regularly and have their
prescriptions filled at one pharmacy.
This was a key finding of a retrospective compliance study of 8,643
New Jersey Medicaid and Medicare patients, aged 65 to 99, with high
blood pressure. The study was conducted by researchers from Brigham
and Women's Hospital, Harvard Medical School, Boston, and published
in the July issue of the American Journal of Hypertension.
"Monane and colleagues found that good compliance, taking medication
correctly at least 80 percent of the time, was best with newer drug
classes such as angiotensin converting enzyme inhibitors and calcium
channel blockers," says Michael Weber, MD, an editor of the American
Journal of Hypertension, the peer-reviewed journal of the American
Society of Hypertension.
"In fact, compared with diuretics, which traditionally have been
recommended as treatment of choice for the elderly, compliance with
the new drug classes was one-and-one-half to two times as great," he
continued. "Other factors that improved compliance were the presence
of known heart disease and, very compellingly, frequency of visits to
the doctor.
"Patients responded far better when they saw the doctor more often
and the presence of known heart disease presumably provided strong
motivation for patients to see their doctor and take the medication."
Nearly 50 million Americans have high blood pressure, called the
silent killer because it prematurely ages the body's arteries and can
lead to strokes, heart attacks and kidney failure, often without
warning.
"Growing evidence now indicates that treatment of hypertension in the
elderly dramatically reduces the probability of serious clinical
events," explains Dr. Weber. "Unfortunately, one of the most
difficult tasks in treating hypertension is persuading patients to
take their medicines on a regular basis."
Authors of the study, "The Effects of Initial Drug Choice and
Comorbidity on Antihypertensive Therapy Compliance," are Mark Monane,
MD; Rhonda L. Bohn, MPH; Jerry H. Gurwitz, MD; Robert J. Glynn, ScD;
Raisa Levin, MS; and Jerry Avorn, MD.
They found that of the 8,643 patients taking antihypertensive
medications during the study period from 1982-1988, the population
was predominately women, 77 percent, and white, 67 percent. The
average number of different prescriptions filled was approximately
seven and more than 20 percent used more than one pharmacy to fill
the prescription.
Diuretics were the most commonly prescribed drug class, accounting
for 50 percent of first prescriptions, followed by beta blockers and
calcium channel blockers at 12 percent each, angiotensin converting
enzyme (ACE) inhibitors, five percent, and others, 17 percent. Four
percent were prescribed multiple drug regimens.
"In the 12 months following an initial antihypertensive prescription,
the average patient had antihypertensive medication available for
only 161 days of the year," the authors said. "In addition, a fifth
(21 percent) of the study cohort did not fill a second prescription
for any antihypertensive medication during the follow-up period. Of
patients started on therapy, only 20 percent achieved good levels of
compliance, defined as 80 percent or greater based on physicians'
instructions for use."
They noted surprise that users of ACE inhibitors and calcium channel
blockers (CCB) in the study were almost twice as likely as diuretic
users to be compliant. "One possible reason for our finding is that,
in our cohort, patients with more severe hypertension or greater
comorbidity may have been more likely to be started on ACE inhibitors
and CCB, whereas those with milder hypertension were started on
diuretic therapy."
The authors warned of the inverse relationship between multiple
medications and compliance as well as the relationship between
multiple pharmacy use and poor compliance, which they believed had
not been documented before.
"The use of multiple pharmacies can lead to the loss of surveillance
and counseling that are possible if a patient receives all his or her
prescriptions from a single-pharmacy option," they said. "In
addition, multiple physician visits may have allowed for the added
opportunity for education and promotion around compliance."
They concluded that "managed care options for the elderly, with the
potential for coordinated care among providers and a centralized
pharmacy system could decrease the frequency of the noncompliance we
observed. Enhanced compliance may offer benefits to both patients and
society in terms of improved blood pressure control as well as
decreased morbidity and cost."
The American Society of Hypertension is the largest US organization
devoted exclusively to hypertension and related cardiovascular
diseases. The organization is committed to alerting physicians,
allied health professionals and the public about new medical options,
facts, research findings and treatment choices designed to reduce the
risk of cardiovascular disease.
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