There's one in every crowd — a rebel who won't follow
the rules. Free spirit, black sheep, pain in the neck,
call them what you will. About two-thirds of patients
on antihypertensive (AH) or lipid-lowering (LL) drugs
stop taking their meds after only six months of treatment.
This alarming estimate comes from a study in the May 23
issue of Archives of Internal Medicine.
Fortunately, the study notes certain
trends that can help physicians predict who's likely
to veer off course and offers some solutions. "Primary
care physicians may increase the likelihood of adherence
with antihypertensive and lipid-lowering medications
by considering both the number of other prescribed medications
and the timing of treatment initiation," says lead author
Dr Rick Chapman, Director of Health Economics at ValueMedics
Research LLC of Falls Church, Virginia.
In this retrospective cohort study,
researchers used an insurance database to record both
prescriptions and health insurance claims of 8,406 patients.
After three months of AH and LL therapy, only 44.7%
of people continued to take both medications regularly.
This figure dropped to 35.9% after six months and leveled
off at 35.8% after one year. And these percentages likely
overestimate adherence since the researchers couldn't
track whether all of the dispensed pills were actually
consumed. Given the proven life-saving ability of these
drugs, the health benefits to be had if patients can
be convinced to stick to their meds are substantial.
ONE
PILL TWO MANY
The study authors identified the most faithful patient
profiles and found that pill burden (the number of pills
taken each day) had the greatest impact. People taking
no pills prior to therapy were nearly twice as likely
to stick to their regimen than those taking six or more
pills per day.
The second most powerful determinant
was age. Those between 55 and 64 were the most vigilant,
while the 45 to 54 year-old set was the most laissez-faire.
Elapsed time after starting AH and LL therapy was the
third highest determinant, with simultaneous prescriptions
leading to the best chance of success.
A brush with cardiovascular disease
seemed to encourage adherence. A myocardial infarction
a year before treatment also seemed to increase adherence,
but histories of diabetes, angina, coronary angioplasty
or hospitalization did not.
"We believe these are important
findings because of the higher cardiovascular disease
risk faced by patients who have both of these conditions,
which makes adherence with treatments especially imperative,"
emphasizes Dr Chapman.
Arch Int Med May 23, 2005;165(10):1147-52
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