THE EFFECTS OF INITIAL-DRUG CHOICE AND COMORBIDITY ON ANTIHYPERTENSIVE THERAPY COMPLIANCE - RESULTS FROM A POPULATION-BASED STUDY IN THE ELDERLY

Approximately half of all elderly patients have elevated blood pressur e, and proper treatment of this disorder leads to decreased cardiovasc ular morbidity in patients 65 and older. This study examined the effec t of initial drug choice and comorbidity on medication compliance. We conducted a retrospective follow-up of 8643 outpatients aged 65 to 99 with newly prescribed antihypertensive therapy (AHT) from 1982 to 1988 iri the New Jersey Medicaid and Medicare programs. Compliance was mea sured in terms of the number of days in which AHT was available to the patient during the 12 months following the initiation of therapy. Odd s ratios (OR) and 95% confidence intervals (CI) for the outcome of goo d compliance (greater than or equal to 80%) were calculated. Tn a logi stic regression model, good compliance (greater than or equal to 80%) was significantly associated with use of newer agents such as angioten sin converting enzyme inhibitors (OR 1.9, 95% CI 1.6 to 2.2) and calci um channel blockers (OR 1.7, 95% CI 1.5 to 2.1) as compared to thiazid es, the presence of comorbid cardiac disease (OR 1.2, 95% CI 1.1 to 1. 2), and multiple physician visits (OR 2.2, 95% CT 1.8 to 2.5). Good co mpliance was inversely associated with use of multiple pharmacies (OR 0.4, 95% Cf 0.4 to 0.5) and number of medications prescribed overall ( OR 0.8, 95% CI 0.7 to 0.9). Drug choice, comorbidity, and health servi ces utilization were significantly associated with AHT compliance and represent important considerations in the management of high blood pre ssure. Noncompliance may be an important cause of treatment failure in elderly hypertensives. (C) 1997 American Journal of Hypertension, Ltd .