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Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

ABSTRACT: Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34-1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67-0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92-0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43-4.51). Polypill users had higher adherence rates compared with the free-dose combination (OR: 1.21, 95% CI 1.2-1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed-dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

SUBMITTER: Dean YE

PROVIDER: S-EPMC11007819 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

Dean Yomna E YE Motawea Karam R KR Shebl Mohamed A MA Elawady Sameh Samir SS Nuhu Kaamel K Abuzuaiter Basel B Awayda Karen K Fouad Ahmed Mahmoud AM Tanas Yousef Y Batista Raquel R Elsayed Ahmed A Hassan Noheir A I F NAIF El-Sakka Amro A AA Hasan Walaa W Husain Raabia R Lois Amanda A Arora Aryan A Arora Abhinav A Ayad Elyas E Elbahaie Mohamed A MA Shah Jaffer J Shady Amr A Chaudhuri Debanik D Aiash Hani H

Journal of clinical hypertension (Greenwich, Conn.) 20240315 4

Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, ...[more]

PMID: 38488773

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Project description:BackgroundObservational studies suggest that there are differences in adherence to antihypertensive medications in different classes. Our objective was to quantify the association between antihypertensive drug class and adherence in clinical settings.Methods and resultsStudies were identified through a systematic search of English-language articles published from the inception of computerized databases until February 1, 2009. Studies were included if they measured adherence to antihypertensives using medication refill data and contained sufficient data to calculate a measure of relative risk of adherence and its variance. An inverse-variance-weighted random-effects model was used to pool results. Hazard ratios (HRs) and odds ratios were pooled separately, and HRs were selected as the primary outcome. Seventeen studies met inclusion criteria. The pooled mean adherence by drug class ranged from 28% for β-blockers to 65% for angiotensin II receptor blockers. There was better adherence to angiotensin II receptor blockers compared with angiotensin-converting enzyme inhibitors (HR, 1.33; 95% confidence interval, 1.13 to 1.57), calcium channel blockers (HR, 1.57; 95% confidence interval, 1.38 to 1.79), diuretics (HR, 1.95; 95% confidence interval, 1.73 to 2.20), and β-blockers (HR, 2.09; 95% confidence interval, 1.14 to 3.85). Conversely, there was lower adherence to diuretics compared with the other drug classes. The same pattern was present when studies that used odds ratios were pooled. After publication bias was accounted for, there were no longer significant differences in adherence between angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors or between diuretics and β-blockers.ConclusionIn clinical settings, there are important differences in adherence to antihypertensives in separate classes, with lowest adherence to diuretics and β-blockers and highest adherence to angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors. However, adherence was suboptimal regardless of drug class.

Project description:ObjectiveTo conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens.Data sourcesWe searched the PubMed and PsycINFO databases, conducted forward searches for articles that cited major review articles, and examined the reference lists of relevant articles.Study eligibility criteria, participants, and interventionsWe included studies on adults in the United States that reported bivariate relationships between depression and medication adherence. We excluded studies on special populations (e.g., substance abusers) that were not representative of the general adult population with chronic diseases, studies on certain diseases (e.g., HIV) that required special adherence protocols, and studies on interventions for medication adherence.Study appraisal and synthesis methodsData abstracted included the study population, the protocol, measures of depression and adherence, and the quantitative association between depression and medication adherence. Synthesis of the data followed established statistical procedures for meta-analysis.ResultsThe estimated odds of a depressed patient being non-adherent are 1.76 times the odds of a non-depressed patient, across 31 studies and 18,245 participants. The association was similar across disease types but was not as strong among studies that used pharmacy records compared to self-report and electronic cap measures.LimitationsThe meta-analysis results are correlations limiting causal inferences, and there is some heterogeneity among the studies in participant characteristics, diseases studied, and methods used.ConclusionsThis analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and we find a new potential effect of adherence measurement type on this relationship. Although this study cannot assess causality, it supports the importance that must be placed on depression in studies that assess adherence and attempt to improve it.

Project description:During early embryogenesis, totipotent cells undergo asymmetric cell divisions, resulting in two compartments in the early embryo: the inner cell mass (ICM) that gives rise to pluripotency cells and an outer layer of trophectoderm (TE). It is only at the 32-64- cell stage when a clear segregation between the two cell types can be observed. This proposes a ‘T’-like model where cells of each stage (2-16-cell stage) of the early embryo undergo a relatively similar changes in their transcriptome and epigenome before specification. Here, we sought to understand whether cells acquiring pluripotency or trophectoderm state, by reprogramming factors (OSKM vs GETM), share similar processes between themselves such as those of the early embryo. To that end, we conducted a comparative parallel meta-analysis on cells undergoing reprogramming to induced pluripotent stem cells (iPSCs) and induced trophoblast stem cells (iTSCs) and examined their transcriptome (i.e. Bulk RNA-seq and SC-RNA-seq), methylome (i.e. RRBS), chromatin accessibility and activity (i.e. ATAC-seq and Chip-seq for H3K4me2 and H3K27ac) and genomic stability (CNVs) along the process. Our analysis revealed that, in contrast to cells of the pre-segregation embryo that mostly resemble each other in each stage, cells undergoing reprogramming to pluripotency and TSC states, exhibit unique and specific trajectories from the beginning of the process till the end, suggesting a ‘V’-like behavior. Although similar processes such as somatic identity loss, proliferation, MET and metabolic shift occur in the two models, each of the processes mostly uses different sets of genes and regulatory elements to induce its own fate. We characterized each trajectory in details and illuminated key aspects that are either shared or distinguished between the two states. Using these analyses, we identified previously unknown markers for faithful reprogramming process and key factors that drastically inhibit both reprogramming processes. We show that this comparative parallel meta-analysis is a powerful tool to understand nuclear reprogramming and cellular plasticity at large.

Project description:IntroductionRecent changes in antiretroviral therapies (ARTs) may have affected medication adherence of people living with human immunodeficiency virus-1 (HIV-1). In this study adherence to ART regimens among patients with HIV-1 (PWH) across the US during a recent time period was examined and study findings were stratified by US region and state.MethodsA retrospective observational study using the Symphony Health Solution Integrated Dataverse database was conducted. Patients ≥ 18 years of age who had a diagnosis of HIV-1 (without an HIV-2 diagnosis) and who were treated with ART between July 2017 and September 2018 (first pharmacy record: index date) were selected from the data source. Both patients who had not been previously treated with ART and those who were treatment experienced were included. Patients were required to have ≥ 1 medical/pharmacy record ≥ 12 months after their index date (follow-up period). Patient characteristics were examined during a 12-month pre-index period. During the follow-up, medication adherence, measured as the proportion of days covered (PDC), was examined for all patients and stratified by US region and state.ResultsAmong 206,474 adult PWH treated with ART, mean age was 47.9 years, 73.4% were male, and 30.0% were Caucasian. The most prevalent comorbid conditions were hyperlipidemia (25.1%), depressive disorders (14.8%), and type 2 diabetes (12.1%). During the follow-up period, mean (standard deviation) PDC was 74.1% (25.9%) among PWH across the US [Midwest: 74.4% (25.5%); Northeast: 74.3% (26.1%); South: 73.2% (26.3%); West: 76.4% (24.8%)]. Across all US regions, > 60% of PWH had adherence < 90% and > 40% had adherence < 80%; the West had the highest adherent population.ConclusionsAmong PWH treated with ART across the US, a majority had suboptimal adherence. Implementation of strategies to improve ART adherence, including clinical consideration of ARTs with high genetic barriers to resistance, is needed in the US.

Dataset Information

Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

Publications

Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

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