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Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study

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Authors
Choi, Kyung Hee; Yu, Yun Mi; Ah, Young-Mi; Chang, Min Jung; Lee, Ju-Yeun
Issue Date
2017-08-24
Publisher
BioMed Central
Citation
BMC Cardiovascular Disorders, 17(1):232
Keywords
HypertensionTreatment persistenceAdherenceAgedVery elderly
Description
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
Abstract

Background
Limited studies have evaluated the medication-taking behavior in very elderly hypertensive patients. The aim of this study was to evaluate the persistence and adherence with antihypertensive agents in treatment-naïve patients, along with other related factors, according to age.

Methods
Adult (19–64 years), elderly (65–79 years), and very elderly (≥80 years) uncomplicated hypertensive patients starting antihypertensive monotherapy were identified from the National Health Insurance claims database. The first-year treatment persistence and adherence rates measured using the medication possession ratio were assessed and compared in these three age cohorts.

Results
After propensity score matching, three age cohorts with 6689 patients each were assembled from 228,925 uncomplicated hypertensive patients who began antihypertensive monotherapy in 2012. The treatment persistence and adherence rates over the first year were the lowest in the very elderly (59.5% and 62.8%, respectively) and highest in the elderly (65.2% and 67.9%, respectively) patients among the three age cohorts (p < 0.001). The adjusted risk for treatment non-persistence was significantly higher in the very elderly (adjusted hazard ratio, 1.20; 95% confidence interval, 1.13–1.27) compared with the elderly. Having more comorbidities, being a beneficiary of medical aid, and having a diagnosis of dementia were unique positive predictors for treatment persistence in the very elderly, along with common predictors such as female sex, dyslipidemia, and an initially chosen antihypertensive therapeutic class other than beta blockers and thiazide diuretics.

Conclusions
Very elderly patients were less likely to continue antihypertensive therapy over the first year compared with their younger counterparts. Our findings suggest that a low comorbidity index and lack of medical aid support negatively affect the treatment persistence in this population.
ISSN
1471-2261
Language
English
URI
http://hdl.handle.net/10371/137547
DOI
https://doi.org/10.1186/s12872-017-0665-4
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College of Pharmacy (약학대학)Research Institute of Pharmaceutical Sciences (종합약학연구소)Journal Papers (저널논문_종합약학연구소)
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