Barrier, JC

Vincze, G

Yang, M

Elsevier - Publisher Connector 

PCV63 OVER-ADHERENCE WITH ANTIHYPERTENSIVE MEDICATIONS AMONG CENTRAL TEXAS VETERANS 

704 Abstracts
PCV62
HYPERTENSION CLINIC AND HYPERTENSION SPECIALIST 
IS A COST-EFFECTIVE TOOL FOR THE DISEASE CONTROL
IMPROVEMENT IN BELARUS
Golubev S
Vitebsk Regional Center for Refractory Hypertension,Vitebsk, Belarus
OBJECTIVES: Evaluate a new service for refractory hyperten-
sion (RH) management in Belarus, an Eastern European country
with a signiﬁcant rise in cardiovascular morbidity, mortality, and
the highest hospital discharge rate for hypertensive emergencies
in Europe. METHODS: One hundred cases of ambulatory
patients with RH consulted during 2003 at Vitebsk Regional
Center for RH (RH-Center created in October, 2002) were ret-
rospectively analyzed, including adherence to and effectiveness
of a recommended treatment regimen during a 6-month period.
The clinical practice at the RH-Center differs from the routine
one in several technologies, including screening for reasons of
refractory states performed by a qualiﬁed hypertension special-
ist; blood pressure (BP) and arterial compliance monitoring;
patient’s quality of life, social stress and support testing to
control the adherence level. RESULTS: In the patient sample
studied, the recommended treatment regimen was preserved in
67 cases, and in 43 (64%) the treatment effectiveness was judged
as sufﬁcient (systolic BP change by 10% or more). In the last 33,
the recommended regimen was substantially changed by general
practitioner (10 patients) or by patient himself (23 cases), lack
of grounded reasons for that being registered in 5 and 20 cases,
correspondingly. Rate of patients’ applying for emergency service
and hospitalization both in adherent and non-adherent portions
of the sample was signiﬁcantly lower compared to a 6-month
period preceding the ﬁrst RH-Center visit. CONCLUSIONS:
The ﬁrst experience of hypertension specialist service implemen-
tation in Belarus was positive. The service combining hyper-
tension specialist care with hemodynamic, metabolic and
psychosocial proﬁling approaches the problem of RH in a sys-
tematic fashion and rational basis. Hence, it can improve cost-
effectiveness of the most expensive and difﬁcult for management
group of hypertensive patients. Our experience should spread to
other Belarusian regions and CIS countries, where proportion of
resistant hypertensives is high.
PCV63
OVER-ADHERENCE WITH ANTIHYPERTENSIVE MEDICATIONS
AMONG CENTRAL TEXAS VETERANS
Yang M,Vincze G, Barner JC
The University of Texas at Austin, Austin,TX, USA
OBJECTIVES: Over-adherence can occur when patients repeat-
edly ﬁll or reﬁll their prescriptions before the exhaustion of their
previous prescription supply. The study objectives were to: 1)
assess antihypertensive medication over-adherence; and 2) iden-
tify characteristics associated with over-adherence. METHODS:
Electronic medical records from Central Texas Veterans Health
Care System were extracted for veterans aged 18 and older who
received at least 2 antihypertensive prescriptions within one year
between September 1995 and December 2003. The prescriptions
were followed for 12 months. Logistic regression was employed
to assess the relationship between antihypertensive class treat-
ment episode and over-adherence (adherence > 100%), while
controlling for demographics (age and gender), clinical variables
(blood pressure control and relevant comorbidities), and treat-
ment episode type (monotherapy or polypharmacy). A p-value
of 0.01 was chosen. RESULTS: A total of 45,628 patients were
included in the analysis and 78,120 treatment episodes were
associated with them. Overall mean adherence rate (AR) was
1.07 ± 1.33 and 50.7% of these treatment episodes had AR > 1.
Logistic regression (N = 61,125) showed increasing age (OR =
1.106, 95%CI: 1.090–1.123), polypharmacy (OR = 1.325,
95%CI: 1.279–1.374), uncontrolled hypertension (OR = 1.111,
95%CI: 1.069–1.154), type-2 diabetes (OR = 1.113, 95%CI:
1.069–1.159), and hyperlipidemia (OR = 1.182, 95%CI:
1.141–1.225) were signiﬁcantly associated with over-adherence,
while cardiovascular conditions (OR = 0.937, 95%CI:
0.901–0.974) were negatively associated with over-adherence.
When these variables were controlled, compared with calcium
channel blockers, use of angiotensin converting enzyme
inhibitors (ACEI) increased (OR = 1.131, 95%CI: 1.078–1.186),
while the use of angiotensin II receptor blockers (OR = 0.680,
95%CI: 0.590–0.783), beta-blockers (OR = 0.932, 95%CI:
0.885–0.981) and “pre-formulated” combination medications
(OR = 0.767, 95%CI: 0.708–0.832) decreased the risk of over-
adherence. CONCLUSIONS: Our study found that ACEI users
were signiﬁcantly at risk for over-adherence. It is important to
further assess the clinical and ﬁnancial consequences of over-
adherence in health care programs such as the Department of
Veterans Affairs, where prescription-supply is not limited.
PCV64
FACTORS ASSOCIATED WITH ADHERENCE TO
ANTIHYPERTENSIVE MEDICATIONS AMONG VETERANS 
IN CENTRAL TEXAS
Vincze G,Yang M, Barner JC
The University of Texas at Austin, Austin,TX, USA
OBJECTIVES: Drug regimen complexity, medication type,
patient characteristics, and comorbidities have been associated
with antihypertensive medication adherence. This study evalu-
ated the association of adherence with demographic (age and
gender), clinical (blood pressure control and comorbidities), 
and medication (type and number prescribed) characteristics.
METHODS: Electronic medical records from Central Texas Vet-
erans Health Care System were extracted for veterans receiving
at least 2 antihypertensive prescriptions within 1 year between
1995 and 2003. Adherence rate (AR) was calculated for each
treatment episode. Multiple regression analysis was employed
and a p-value of 0.01 was chosen. RESULTS: Study participants’
(N = 34,719) mean AR was 0.95 ± 0.28, ranging from 0 to 1.5.
Participants were predominantly males (95.3%), with an average
age of 62.8 ± 12.6 years. More than two-thirds (68.3%) of
patients’ treatment episodes (N = 56,875) were part of multiple
therapy. Uncontrolled blood pressure was prevalent (75.8%),
and many patients had diabetes (20.5%), cardiovascular com-
plications (22.3%), and hyperlipidemia (30.7%). Multiple
regression analysis showed that older patients on multiple ther-
apies had signiﬁcantly higher AR’s. Uncontrolled blood pressure,
type-two diabetes, and hyperlipidemia were also associated with
higher AR; whereas cardiovascular complications and type-
one diabetes were associated with lower AR. Controlling for 
the above variables, adherence was signiﬁcantly higher for
angiotensin converting enzyme inhibitors (ACEI) and lower 
for angiotensin II receptor blocker, beta blocker, diuretic, other
(including aldosterone receptor blockers, central alpha agonists,
diazoxide, and peripheral vasodilators) and pre-formulated com-
bination therapies. While the model demonstrated overall sig-
niﬁcance (p < 0.0001), it only explained 2.8% of the variance.
CONCLUSIONS: The study showed that patient, clinical, and
medication characteristics were associated with medication
adherence. Patients who had more comorbidities and those on
multiple therapies seemed to have higher adherence levels. Nev-
ertheless, our results need to be interpreted with caution, due to
the small proportion of variance explained by the model and the
range of adherence observed.


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PCV63 OVER-ADHERENCE WITH ANTIHYPERTENSIVE MEDICATIONS AMONG CENTRAL TEXAS VETERANS

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