Long-term persistence and adherence to blood pressure lowering agents among older Australians

Si Si, Richard Ofori-Asenso, Tom Briffa, Frank M. Sanfilippo, Jenni Ilomaki, Xi Wen Qin, Mark Tacey, Christopher M. Reid, Danny Liew

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

Purpose: Poor adherence and persistence to blood pressure lowering (BPL) agents leads to increased risk of morbidity and mortality. The aim of this study was to investigate the long-term adherence, persistence, and re-initiation of BPL agents among older Australians (aged ≥65 years). Methods: We utilised the Pharmaceutical Benefits Scheme data covering a 10% random sample of Australians. We identified 31 088 older Australians (mean age, 75.4 years; 56% females) with newly initiated BPL therapy from 2008 to 2016. Adherence was assessed using the proportion of days covered (PDC) at 6-month intervals. Discontinuation was defined as ≥90 days without BPL coverage. Cox regression was applied to compare the time till the first discontinuation of BPL agents across different BPL categories and among various subgroups. Results: Over a mean follow-up of 3.8 years, 40% to 70% of older Australians received a BPL agent discontinued it. The median time to discontinuation ranged from 159 to 373 days. Persistence with fixed dose combinations was the best (68%, 58%, and 41% at 6, 12, and 36 months respectively), followed by angiotensin II receptor blockers (69%, 58%, and 40%), beta-blockers (67%, 54%, and 36%), angiotensin converting enzyme inhibitors (62%, 51%, and 34%), calcium channel blockers (57%, 47%, and 31%), and diuretics (59%, 41%, and 23%). Among those who discontinued, 30% to 50% re-initiated, with median days to re-initiation ranging from 177 to 302. Only 21% to 42% of the study population maintained “good” adherence (PDC ≥ 0.8) to BPLs over 3 years. Conclusion: Compliance to BPL agents is poor among older Australians. Interventions to enhance adherence and persistence to BPL agents are needed.

Original languageEnglish
Pages (from-to)788-795
Number of pages8
JournalPharmacoepidemiology and Drug Safety
Volume28
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • adherence
  • Australia
  • blood pressure lowering agents
  • older population
  • persistence
  • pharmacoepidemiology

Cite this

Si, Si ; Ofori-Asenso, Richard ; Briffa, Tom ; Sanfilippo, Frank M. ; Ilomaki, Jenni ; Qin, Xi Wen ; Tacey, Mark ; Reid, Christopher M. ; Liew, Danny. / Long-term persistence and adherence to blood pressure lowering agents among older Australians. In: Pharmacoepidemiology and Drug Safety. 2019 ; Vol. 28, No. 6. pp. 788-795.
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title = "Long-term persistence and adherence to blood pressure lowering agents among older Australians",
abstract = "Purpose: Poor adherence and persistence to blood pressure lowering (BPL) agents leads to increased risk of morbidity and mortality. The aim of this study was to investigate the long-term adherence, persistence, and re-initiation of BPL agents among older Australians (aged ≥65 years). Methods: We utilised the Pharmaceutical Benefits Scheme data covering a 10{\%} random sample of Australians. We identified 31 088 older Australians (mean age, 75.4 years; 56{\%} females) with newly initiated BPL therapy from 2008 to 2016. Adherence was assessed using the proportion of days covered (PDC) at 6-month intervals. Discontinuation was defined as ≥90 days without BPL coverage. Cox regression was applied to compare the time till the first discontinuation of BPL agents across different BPL categories and among various subgroups. Results: Over a mean follow-up of 3.8 years, 40{\%} to 70{\%} of older Australians received a BPL agent discontinued it. The median time to discontinuation ranged from 159 to 373 days. Persistence with fixed dose combinations was the best (68{\%}, 58{\%}, and 41{\%} at 6, 12, and 36 months respectively), followed by angiotensin II receptor blockers (69{\%}, 58{\%}, and 40{\%}), beta-blockers (67{\%}, 54{\%}, and 36{\%}), angiotensin converting enzyme inhibitors (62{\%}, 51{\%}, and 34{\%}), calcium channel blockers (57{\%}, 47{\%}, and 31{\%}), and diuretics (59{\%}, 41{\%}, and 23{\%}). Among those who discontinued, 30{\%} to 50{\%} re-initiated, with median days to re-initiation ranging from 177 to 302. Only 21{\%} to 42{\%} of the study population maintained “good” adherence (PDC ≥ 0.8) to BPLs over 3 years. Conclusion: Compliance to BPL agents is poor among older Australians. Interventions to enhance adherence and persistence to BPL agents are needed.",
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Long-term persistence and adherence to blood pressure lowering agents among older Australians. / Si, Si; Ofori-Asenso, Richard; Briffa, Tom; Sanfilippo, Frank M.; Ilomaki, Jenni; Qin, Xi Wen; Tacey, Mark; Reid, Christopher M.; Liew, Danny.

In: Pharmacoepidemiology and Drug Safety, Vol. 28, No. 6, 06.2019, p. 788-795.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Long-term persistence and adherence to blood pressure lowering agents among older Australians

AU - Si, Si

AU - Ofori-Asenso, Richard

AU - Briffa, Tom

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AU - Qin, Xi Wen

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AB - Purpose: Poor adherence and persistence to blood pressure lowering (BPL) agents leads to increased risk of morbidity and mortality. The aim of this study was to investigate the long-term adherence, persistence, and re-initiation of BPL agents among older Australians (aged ≥65 years). Methods: We utilised the Pharmaceutical Benefits Scheme data covering a 10% random sample of Australians. We identified 31 088 older Australians (mean age, 75.4 years; 56% females) with newly initiated BPL therapy from 2008 to 2016. Adherence was assessed using the proportion of days covered (PDC) at 6-month intervals. Discontinuation was defined as ≥90 days without BPL coverage. Cox regression was applied to compare the time till the first discontinuation of BPL agents across different BPL categories and among various subgroups. Results: Over a mean follow-up of 3.8 years, 40% to 70% of older Australians received a BPL agent discontinued it. The median time to discontinuation ranged from 159 to 373 days. Persistence with fixed dose combinations was the best (68%, 58%, and 41% at 6, 12, and 36 months respectively), followed by angiotensin II receptor blockers (69%, 58%, and 40%), beta-blockers (67%, 54%, and 36%), angiotensin converting enzyme inhibitors (62%, 51%, and 34%), calcium channel blockers (57%, 47%, and 31%), and diuretics (59%, 41%, and 23%). Among those who discontinued, 30% to 50% re-initiated, with median days to re-initiation ranging from 177 to 302. Only 21% to 42% of the study population maintained “good” adherence (PDC ≥ 0.8) to BPLs over 3 years. Conclusion: Compliance to BPL agents is poor among older Australians. Interventions to enhance adherence and persistence to BPL agents are needed.

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