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Canadian Journal of Cardiology

Antihypertensive Medication Use, Adherence, Stops, and Starts in Canadians With Hypertension

Published:April 23, 2012DOI:https://doi.org/10.1016/j.cjca.2012.01.014

      Abstract

      Background

      Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions.

      Methods

      Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined.

      Results

      The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use.

      Conclusions

      Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.

      Résumé

      Introduction

      Il semble que certains des plus grands obstacles à la maîtrise de la pression artérielle sont la non-prescription de médicaments antihypertenseurs et la non-adhésion aux médicaments d'ordonnance.

      Méthodes

      Les données rapportées par les 6 017 Canadiens ayant un diagnostic d'hypertension qui ont répondu à l'Enquête sur la santé dans les collectivités canadiennes de 2008 et à l'Enquête sur les personnes ayant une maladie chronique au Canada de 2009 ont été étudiées.

      Résultats

      La majorité (82 %) des individus ayant un diagnostic d'hypertension ont rapporté avoir utilisé des médicaments antihypertenseurs. Les principales raisons pour ne pas prendre de médicaments étaient qu'ils n'avaient pas été prescrits (42 %) ou que la pression artérielle avait été maîtrisée sans médicaments (45 %). Parmi ceux qui n'avaient pas pris de médicaments antihypertenseurs en 2008 (n = 963), 18 % avaient commencé des médicaments antihypertenseurs en 2009, et parmi ceux qui avaient initialement pris les médicaments (n = 5 058), 5 % les avaient cessés. Parmi ceux qui avaient pris les médicaments en 2009, 89 % ont indiqué qu'ils avaient pris le médicament comme prescrit, et 10 % ont indiqué qu'ils avaient occasionnellement omis une dose. Les participants qui avaient été récemment diagnostiqués et qui ne mesuraient pas leur pression artérielle à la maison, qui n'avaient pas un plan de maîtrise de la pression artérielle ou qui n'avaient pas reçu de directives sur la manière de prendre les médicaments étaient moins susceptibles de prendre des médicaments antihypertenseurs; des facteurs similaires sont généralement associés à la cessation du médicament antihypertenseur.

      Conclusions

      Tels les taux élevés de maîtrise de l'hypertension, la plupart des Canadiens ayant reçu un diagnostic d'hypertension prennent des médicaments antihypertenseurs et disent s'engager à suivre leur traitement. La vaste mise en œuvre de stratégies pour la prise en charge autonome de la maîtrise de la pression artérielle et des directives standardisées sur les médicaments antihypertenseurs peuvent davantage optimiser le traitement à l'aide de médicaments.
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      References

        • World Health Organization
        Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks.
        in: World Health Organization, Geneva, Switzerland2009: 1-62
        • Heidenreich P.A.
        • Trogdon J.G.
        • Khavjou M.A.
        • et al.
        AHA policy statement: forecasting the future of cardiovasular disease in the United States.
        Circulation. 2011; 123: 933-944
        • Gaziano T.A.
        • Bitton A.
        • Anand S.
        • Weinstein M.C.
        The global cost of nonoptimal blood pressure.
        J Hypertens. 2009; 27: 1472-1477
        • Kearney P.M.
        • Whelton M.
        • Reynolds K.
        • Whelton P.K.
        • He J.
        Worldwide prevalence of hypertension: a systematic review.
        J Hypertens. 2004; 22: 11-19
        • Kotchen T.A.
        The search for strategies to control hypertension.
        Circulation. 2010; 122: 1141-1143
        • Lewanczuk R.
        Innovations in primary care: implications for hypertension detection and treatment.
        Can J Cardiol. 2006; 22: 614-616
        • World Health Organization
        Adherence to Long-Term Therapies: Evidence for Action.
        World Health Organization, Geneva, Switzerland2003
        • McAlister F.A.
        • Wilkins K.
        • Joffres M.
        • et al.
        Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades.
        CMAJ. 2011; 183: 1007-1013
        • Campbell N.R.
        • Onysko J.
        The Outcomes Research Task Force and the Canadian Hypertension Education Program.
        Can J Cardiol. 2006; 22: 556-558
        • Statistics Canada
        Survey on Living with Chronic Diseases in Canada: User Guide.
        (Accessed December 15, 2011)
        • Statistics Canada
        Canadian Community Health Survey - Annual Component (CCHS).
        (Accessed January 20, 2012)
        • Caro J.J.
        • Speckman J.L.
        • Salas M.
        • Raggio G.
        • Jackson J.D.
        Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data.
        CMAJ. 1999; 160: 41-46
        • Bourgault C.
        • Senecal M.
        • Brisson M.
        • Marentette M.A.
        • Gregoire J.-P.
        Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study.
        J Hum Hypertens. 2005; 19: 607-613
        • Caro J.J.
        • Salas M.
        • Speckman J.L.
        • Raggio G.
        • Jackson J.D.
        Persistence with treatment for hypertension in actual practice.
        CMAJ. 1999; 160: 31-37
        • Cutler D.M.
        • Everett W.
        Thinking outside the pillbox—medication adherence as a priority for health care reform.
        N Engl J Med. 2010; 362: 1553-1555
        • Vawter L.
        • Tong X.
        • Gemilyan M.
        • Yoon P.W.
        Barriers to antihypertensive medication adherence among adults—United States, 2005.
        J Clin Hypertens (Greenwich). 2008; 10: 922-929
        • Burke T.A.
        • Sturkenboom M.C.
        • Lu S.
        • Wentworth C.E.
        • Lin Y.
        • Rhoads G.G.
        Discontinuation of antihypertensive drugs among newly diagnosed hypertensive patients in UK general practice.
        J Hypertens. 2006; 24: 1201-1208
        • Campbell N.R.
        • Sheldon T.
        The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies?.
        Curr Opin Cardiol. 2010; 25: 366-372
        • Joffres M.R.
        • Hamet P.
        • MacLean D.R.
        • L'Italien G.J.
        • Fodor G.
        Distribution of blood pressure and hypertension in Canada and the United States.
        Am J Hypertens. 2001; 14: 1099-1105
        • Osterberg L.
        • Blaschke T.
        Adherence to medication.
        N Engl J Med. 2005; 353: 487-497
        • Schroeder K.
        • Fahey T.
        • Ebrahim S.
        How can we improve adherence to blood pressure-lowering medication in ambulatory care?.
        Arch Intern Med. 2004; 164: 722-732
        • Cappuccio F.P.
        • Kerry S.M.
        • Forbes L.
        • Donald A.
        Blood pressure control by home monitoring: meta-analysis of randomised trials.
        BMJ. 2004; 329: 145-150
        • Shi L.
        • Liu J.
        • Fonseca V.
        • Walker P.
        • Kalsekar A.
        • Pawaskar M.
        Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis.
        Health Qual Life Outcomes. 2010; 8: 99
        • Zeller A.
        • Ramseier E.
        • Teagtmeyer A.
        • Battegay E.
        Patients' self-reported adherence to cardiovascular medication using electronic monitors as comparators.
        Hypertens Res. 2008; 31: 2037-2043
        • Garber M.C.
        • Nau D.P.
        • Erickson S.R.
        • Aikens J.E.
        • Lawrence J.B.
        The concordance of self-report with other measures of medication adherence: a summary of the literature.
        Med Care. 2004; 42: 649-652
        • Friedman O.
        • McAlister F.
        • Yun L.
        • Campbell N.
        • Tu K.
        • Canadian Hypertension Education Program Outcomes Research Taskforce
        Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario.
        Am J Med. 2010; 123: 173-182
        • Wetzels G.E.C.
        • Nelemans P.
        • Schouten J.S.
        • Prins M.H.
        Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review.
        J Hypertens. 2004; 22: 1849-1855
        • Robitaille C.
        • Dai S.
        • Waters C.
        • et al.
        Diagnosed hypertension in Canada: incidence, prevalence and associated mortality.
        CMAJ. 2012; 184: E49-E56