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CDC Vital Signs: Helping Adults With HTN Adhere to Their Medication Regimens

10/5/2016 11:15:00 AM

Information sourced from CDC: Morbidity and Mortality Weekly Report (MMWR) Early Release September 13, 2016 / 65 [Free full-text MMWR article PDF] Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014 [EXCERPTS] Abstract Introduction: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. Methods: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of Less than 80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries’ state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. Results: Overall, 26.3% (4.9 million) of Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen. Nonadherence differed by multiple factors, including medication class (range: 16.9% for angiotensin II receptor blockers to 28.9% for diuretics); race-ethnicity (24.3% for non-Hispanic whites, 26.3% for Asian/Pacific Islanders, 33.8% for Hispanics, 35.7% for blacks, and 38.8% for American Indians/Alaska Natives); and state of residence (range 18.7% for North Dakota to 33.7% for the District of Columbia). Considerable county-level variation in nonadherence was found; the highest nonadherence tended to occur in the southern United States (U.S. Census region nonadherence = 28.9% [South], 26.7% [West], 24.1% [Northeast], and 22.8% [Midwest])[.] Conclusions and Implications for Public Health Practice: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes. Key Points • Cardiovascular disease (heart disease and stroke) is the leading cause of death in the United States. • Hypertension, or high blood pressure, is a primary risk factor for heart disease and stroke, and approximately 70% of adults aged Greater than or equal to 65 years have the condition. Only about half of persons with high blood pressure have it under control (i.e., blood pressure less than 140/90 mm Hg). • Nonadherence, or not following a health care professional’s instructions concerning taking their prescribed blood pressure medicine, is a well-known reason for uncontrolled high blood pressure and an important risk factor for adverse cardiovascular disease outcomes and increased health care costs. • In this study, 26.3% (4.9 million) [of] Medicare Part D beneficiaries aged ≥65 years using blood pressure medicine were considered nonadherent. • Different groups and geographic regions had a high proportion of beneficiaries classified as nonadherent. For example, 24.3% of whites, 26.3% of Asian/Pacific Islanders, 33.8% of Hispanics, 35.7% of blacks, and 38.8% of American Indians or Alaska Natives were classified as being nonadherent. In addition, socioeconomic status classifications showed differences, with 32.1% of persons with a low-income subsidy being classified as nonadherent, compared with 25.4% of persons with no subsidy. The highest nonadherence prevalence tended to occur in the southern United States. • Factors and opportunities were identified that could be addressed by prescribers, health systems, and payers to improve adherence, including, especially among older adults, simplifying their blood pressure medication regimen. • Additional information is available at http://www.cdc.gov/vitalsigns.

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