Barriers to and Determinants of Medication Adherence in Hypertension Management: Perspective of the Cohort Study of Medication Adherence Among Older Adults
Section snippets
Collection of data to understand barriers to antihypertensive medication adherence
A sample size of 2,000 participants was selected to provide adequate statistical power to detect clinically important and meaningful differences between persons with and without low adherence to their antihypertensive medication. CoSMO has 80% power to detect prevalence ratios of low medication adherence, as low as 1.2 for cross-sectional analyses, and as low as 1.4 for longitudinal analyses of reductions in medication adherence, depending on the prevalence of low medication adherence, the
New findings regarding antihypertensive medication adherence in older adults
Baseline characteristics of the CoSMO participants are presented in Table 2. Those younger than 75 years, compared with those 75 years and older, were more likely to be black, a high-school graduate, married, have at least one dependent, a lower comorbidity score, and a higher BMI. Women enrolled in the study, compared with men, were significantly older, less likely to be married, less likely to have hypertension for more than 10 years, and have higher cholesterol levels, higher BMI, and a
Discussion
Relatively little is known about the relationship of demographics to medication adherence in older adults, and few studies have examined the validity of self-report adherence measures in the elderly.18 In the CoSMO study of older adults with hypertension, a substantial portion had low adherence to their antihypertensive medications and uncontrolled blood pressure. Black participants and individuals less than 75 years old had lower adherence levels compared with whites and individuals 75 years
Summary and future directions
Low adherence to antihypertensive medication is common and contributes to poor blood-pressure control and adverse outcomes. There is lack of understanding of how patient-specific barriers influence low medication adherence and how effective interventions can be targeted to overcome barriers and improve adherence behavior in adults with hypertension. The CoSMO study is designed to provide data on the factors influencing medication adherence and lay the groundwork for interventions to improve
Acknowledgments
The authors gratefully acknowledge the contributions of the CoSMO Advisory Panel members, including Edward Frohlich MD (Ochsner Clinic Foundation, New Orleans, Louisiana), Jiang He MD, PhD (Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana), Richard Re MD (Ochsner Clinic Foundation, New Orleans, Louisiana), Paul K Whelton MD (Loyola University Medical Center, Chicago, Illinois).
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The project described was supported by Grant Number R01 AG022536 from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.