Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1996 Dec;86(12):1805–1808. doi: 10.2105/ajph.86.12.1805

Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender, and race.

M Monane 1, R L Bohn 1, J H Gurwitz 1, R J Glynn 1, R Levin 1, J Avorn 1
PMCID: PMC1380739  PMID: 9003143

Abstract

OBJECTIVES: This study measured compliance and related demographic factors in a retrospective cohort of 4068 elderly outpatients newly starting antihypertensive therapy from 1982 through 1988. METHODS: Logistic regression modeling of data from the New Jersey Medicaid program was used. RESULTS: These patients filled antihypertensive prescriptions covering an average of only 179 days in the 365-day follow-up period (49%) Good compliance (> or = 80%) was associated with advanced age (odds ratio [OR] = 2.12, for patients 85 or older) and White race (OR = 0.55 for Blacks). There was no relationship between compliance and gender. CONCLUSIONS: Despite the efficacy of antihypertensive therapy in preventing cardiovascular morbidity, such high rates of noncompliance may contribute to suboptimal patient outcomes.

Full text

PDF
1807

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aday L. A., Andersen R. M. The national profile of access to medical care: where do we stand? Am J Public Health. 1984 Dec;74(12):1331–1339. doi: 10.2105/ajph.74.12.1331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Amery A., Birkenhäger W., Brixko P., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985 Jun 15;1(8442):1349–1354. doi: 10.1016/s0140-6736(85)91783-0. [DOI] [PubMed] [Google Scholar]
  3. Caldwell J. R., Cobb S., Dowling M. D., de Jongh D. The dropout problem in antihypertensive treatment. A pilot study of social and emotional factors influencing a patient's ability to follow antihypertensive treatment. J Chronic Dis. 1970 Feb;22(8):579–592. doi: 10.1016/0021-9681(70)90034-2. [DOI] [PubMed] [Google Scholar]
  4. Col N., Fanale J. E., Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990 Apr;150(4):841–845. [PubMed] [Google Scholar]
  5. Concato J., Feinstein A. R., Holford T. R. The risk of determining risk with multivariable models. Ann Intern Med. 1993 Feb 1;118(3):201–210. doi: 10.7326/0003-4819-118-3-199302010-00009. [DOI] [PubMed] [Google Scholar]
  6. Cooper J. K., Love D. W., Raffoul P. R. Intentional prescription nonadherence (noncompliance) by the elderly. J Am Geriatr Soc. 1982 May;30(5):329–333. doi: 10.1111/j.1532-5415.1982.tb05623.x. [DOI] [PubMed] [Google Scholar]
  7. Crawford S. L., McGraw S. A., Smith K. W., McKinlay J. B., Pierson J. E. Do blacks and whites differ in their use of health care for symptoms of coronary heart disease? Am J Public Health. 1994 Jun;84(6):957–964. doi: 10.2105/ajph.84.6.957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dahlöf B., Lindholm L. H., Hansson L., Scherstén B., Ekbom T., Wester P. O. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) Lancet. 1991 Nov 23;338(8778):1281–1285. doi: 10.1016/0140-6736(91)92589-t. [DOI] [PubMed] [Google Scholar]
  9. Darnell J. C., Murray M. D., Martz B. L., Weinberger M. Medication use by ambulatory elderly. An in-home survey. J Am Geriatr Soc. 1986 Jan;34(1):1–4. doi: 10.1111/j.1532-5415.1986.tb06332.x. [DOI] [PubMed] [Google Scholar]
  10. Eisen S. A., Miller D. K., Woodward R. S., Spitznagel E., Przybeck T. R. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med. 1990 Sep;150(9):1881–1884. [PubMed] [Google Scholar]
  11. Fisher E. S., Whaley F. S., Krushat W. M., Malenka D. J., Fleming C., Baron J. A., Hsia D. C. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992 Feb;82(2):243–248. doi: 10.2105/ajph.82.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fletcher A. E., Franks P. J., Bulpitt C. J. The effect of withdrawing antihypertensive therapy: a review. J Hypertens. 1988 Jun;6(6):431–436. doi: 10.1097/00004872-198806000-00001. [DOI] [PubMed] [Google Scholar]
  13. Gurwitz J. H., Avorn J., Bohn R. L., Glynn R. J., Monane M., Mogun H. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994 Sep 14;272(10):781–786. [PubMed] [Google Scholar]
  14. Gurwitz J. H., Bohn R. L., Glynn R. J., Monane M., Mogun H., Avorn J. Antihypertensive drug therapy and the initiation of treatment for diabetes mellitus. Ann Intern Med. 1993 Feb 15;118(4):273–278. doi: 10.7326/0003-4819-118-4-199302150-00005. [DOI] [PubMed] [Google Scholar]
  15. Gurwitz J. H., Glynn R. J., Monane M., Everitt D. E., Gilden D., Smith N., Avorn J. Treatment for glaucoma: adherence by the elderly. Am J Public Health. 1993 May;83(5):711–716. doi: 10.2105/ajph.83.5.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Haynes R. B., Gibson E. S., Taylor D. W., Bernholz C. D., Sackett D. L. Process versus outcome in hypertension: a positive result. Circulation. 1982 Jan;65(1):28–33. doi: 10.1161/01.cir.65.1.28. [DOI] [PubMed] [Google Scholar]
  17. Horwitz R. I., Horwitz S. M. Adherence to treatment and health outcomes. Arch Intern Med. 1993 Aug 23;153(16):1863–1868. [PubMed] [Google Scholar]
  18. Insua J. T., Sacks H. S., Lau T. S., Lau J., Reitman D., Pagano D., Chalmers T. C. Drug treatment of hypertension in the elderly: a meta-analysis. Ann Intern Med. 1994 Sep 1;121(5):355–362. doi: 10.7326/0003-4819-121-5-199409010-00008. [DOI] [PubMed] [Google Scholar]
  19. James S. A., Wagner E. H., Strogatz D. S., Beresford S. A., Kleinbaum D. G., Williams C. A., Cutchin L. M., Ibrahim M. A. The Edgecombe County (NC) High Blood Pressure Control Program: II. Barriers to the use of medical care among hypertensives. Am J Public Health. 1984 May;74(5):468–472. doi: 10.2105/ajph.74.5.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Janz N. K., Becker M. H. The Health Belief Model: a decade later. Health Educ Q. 1984 Spring;11(1):1–47. doi: 10.1177/109019818401100101. [DOI] [PubMed] [Google Scholar]
  21. Kaplan N. M. The appropriate goals of antihypertensive therapy: neither too much nor too little. Ann Intern Med. 1992 Apr 15;116(8):686–690. doi: 10.7326/0003-4819-116-8-686. [DOI] [PubMed] [Google Scholar]
  22. Maronde R. F., Chan L. S., Larsen F. J., Strandberg L. R., Laventurier M. F., Sullivan S. R. Underutilization of antihypertensive drugs and associated hospitalization. Med Care. 1989 Dec;27(12):1159–1166. doi: 10.1097/00005650-198912000-00007. [DOI] [PubMed] [Google Scholar]
  23. McCombs J. S., Nichol M. B., Newman C. M., Sclar D. A. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care. 1994 Mar;32(3):214–226. doi: 10.1097/00005650-199403000-00003. [DOI] [PubMed] [Google Scholar]
  24. Monane M., Bohn R. L., Gurwitz J. H., Glynn R. J., Avorn J. Noncompliance with congestive heart failure therapy in the elderly. Arch Intern Med. 1994 Feb 28;154(4):433–437. [PubMed] [Google Scholar]
  25. Monane M., Bohn R. L., Gurwitz J. H., Glynn R. J., Choodnovskiy I., Avorn J. Topical glaucoma medications and cardiovascular risk in the elderly. Clin Pharmacol Ther. 1994 Jan;55(1):76–83. doi: 10.1038/clpt.1994.13. [DOI] [PubMed] [Google Scholar]
  26. Monane M., Glynn R. J., Gurwitz J. H., Bohn R. L., Levin R., Avorn J. Trends in medication choices for hypertension in the elderly. The decline of the thiazides. Hypertension. 1995 May;25(5):1045–1051. doi: 10.1161/01.hyp.25.5.1045. [DOI] [PubMed] [Google Scholar]
  27. Montamat S. C., Cusack B. J., Vestal R. E. Management of drug therapy in the elderly. N Engl J Med. 1989 Aug 3;321(5):303–309. doi: 10.1056/NEJM198908033210507. [DOI] [PubMed] [Google Scholar]
  28. Psaty B. M., Savage P. J., Tell G. S., Polak J. F., Hirsch C. H., Gardin J. M., McDonald R. H., Jr Temporal patterns of antihypertensive medication use among elderly patients. The Cardiovascular Health Study. JAMA. 1993 Oct 20;270(15):1837–1841. [PubMed] [Google Scholar]
  29. Rosner B., Polk B. F. The implications of blood pressure variability for clinical and screening purposes. J Chronic Dis. 1979;32(6):451–461. doi: 10.1016/0021-9681(79)90105-x. [DOI] [PubMed] [Google Scholar]
  30. Soumerai S. B., Avorn J., Ross-Degnan D., Gortmaker S. Payment restrictions for prescription drugs under Medicaid. Effects on therapy, cost, and equity. N Engl J Med. 1987 Aug 27;317(9):550–556. doi: 10.1056/NEJM198708273170906. [DOI] [PubMed] [Google Scholar]
  31. Stewart R. B., Caranasos G. J. Medication compliance in the elderly. Med Clin North Am. 1989 Nov;73(6):1551–1563. doi: 10.1016/s0025-7125(16)30616-2. [DOI] [PubMed] [Google Scholar]
  32. Stockwell D. H., Madhavan S., Cohen H., Gibson G., Alderman M. H. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994 Nov;84(11):1768–1774. doi: 10.2105/ajph.84.11.1768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Strandberg L. R. Drugs as a reason for nursing home admissions. J Am Health Care Assoc. 1984 Jul;10(4):20–23. [PubMed] [Google Scholar]
  34. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  35. Wilber J. A., Barrow J. G. Hypertension--a community problem. Am J Med. 1972 May;52(5):653–663. doi: 10.1016/0002-9343(72)90055-1. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES