Predictors of adherence with antihypertensive and lipid-lowering therapy
Predictors of adherence with antihypertensive and lipid-lowering therapy
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DOI：
10.1001/archinte.165.10.1147
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发表时间：
2005-05-23
影响因子：
--
通讯作者：
Schwartz, JS
中科院分区：
文献类型：
--
作者：
Chapman, RH;Benner, JS;Schwartz, JS
背景资料：合并高血压和血脂异常的患者发生心血管疾病的风险很高，可以通过治疗大大减轻。因此，坚持处方药物治疗对这些患者尤为重要。本研究进行了描述的模式和预测因素的坚持与伴随的抗高血压（AH）和降脂（LL）therapy.Methods：这项回顾性队列研究研究8406登记在美国管理的医疗计划谁开始治疗AH和LL治疗在90天内。依从性测量为开始合并治疗后每个3个月间隔内所涵盖的天数比例（平均随访时间，12.9个月）。如果患者的处方足以覆盖两类药物至少80%的天数，则认为患者依从。一个多变量回归模型评估了潜在的predictors of adherence.Results：坚持AH和LL治疗的患者百分比急剧下降后开始治疗，44.7%，35.9%，和35.8%的患者坚持在3，6，和12个月，分别。调整后的年龄，性别和其他潜在的预测因素，患者更有可能是遵守，如果他们开始所有和LL治疗一起，有冠心病或充血性心力衰竭的历史，或采取较少的其他medications.Conclusions：坚持与伴随AH和LL治疗是差的，只有1/3的患者坚持与两种药物在6个月。医生可以通过同时启动AH和LL治疗以及减少药丸负担来显著提高依从性。
Background: Patients with comorbid hypertension and dyslipidemia are at high risk for cardiovascular disease, which can be considerably mitigated by treatment. Adherence with prescribed drug therapy is, therefore, especially important in these patients. This study was undertaken to describe the patterns and predictors of adherence with concomitant antihypertensive (AH) and lipid-lowering (LL) therapy.Methods: This retrospective cohort study examined 8406 enrollees in a US managed care plan who initiated treatment with AH and LL therapy within a 90-day period. Adherence was measured as the proportion of days covered in each 3-month interval following initiation of concomitant therapy (mean follow-up, 12.9 months). Patients were considered adherent if they had filled prescriptions sufficient to cover at least 80% of days with both classes of medications. A multivariate regression model evaluated potential predictors of adherence.Results: The percentage of patients adherent with both AH and LL therapy declined sharply following treatment initiation, with 44.7%, 35.9%, and 35.8% of patients adherent at 3, 6, and 12 months, respectively. After adjustment for age, sex, and other potential predictors, patients were more likely to be adherent if they initiated All and LL therapy together, had a history of coronary heart disease or congestive heart failure, or took fewer other medications.Conclusions: Adherence with concomitant AH and LL therapy is poor, with only 1 in 3 patients adherent with both medications at 6 months. Physicians may be able to significantly improve adherence by initiating AH and LL therapy concomitantly and by reducing pill burden.