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Vol. 32, No. 6, 2010
Issue release date: December 2010
Section title: Original Report: Patient-Oriented, Translational Research
Am J Nephrol 2010;32:541–548
(DOI:10.1159/000321688)

Adherence to Antihypertensive Agents and Blood Pressure Control in Chronic Kidney Disease

Schmitt K.E. · Edie C.F. · Laflam P. · Simbartl L.A. · Thakar C.V.
aCincinnati Veterans Affairs Medical Center, and bDivision of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA

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Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: 8/23/2010
Accepted: 10/4/2010
Published online: 11/2/2010

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: http://www.karger.com/AJN

Abstract

Background: Hypertension is a modifiable risk factor in chronic kidney disease (CKD), and medication adherence (MA) is critical in reaching the treatment goals. Patterns of MA for antihypertensive agents and its impact on blood pressure (BP) in CKD practice settings are not well studied. Methods: We examined 7,227 CKD patients receiving at least one antihypertensive prescription between 2006 and 2007. Outpatient BP measurements were averaged as high (>130/ 80 mm Hg) versus normal (others). MA was calculated using medication possession ratio (MPR = actual treatment days/total possible treatment days). Good versus Poor MA (MPR ≧0.8 vs. <0.8) groups were compared for differences in demographic, co-morbid, and laboratory variables. The relationship between MA and BP was examined by logistic regression. Results: 4,867/7,227 patients (67%) had Good MA; the frequency of patients with Good MA varied by each drug class (p < 0.0001). MPR declined with worsening CKD (stage III: MPR = 0.83 standard deviation (SD 0.18); stage IV: MPR = 0.78 (SD 0.22); stage V: MPR = 0.75 (SD 0.21); p < 0.0001). Hospitalization episodes also negatively impacted adherence. Only 35% of CKD patients had normal BP. By multivariate analysis, Poor MA was associated with high BP (odds ratio 1.23, 95% confidence interval 1.11–1.37). Conclusions: 33% of CKD patients have Poor MA for antihypertensive agents, and MA worsens with declining renal function. Poor MA is associated with a 23% greater risk of uncontrolled hypertension. Monitoring and improving adherence in CKD practice may improve outcomes.


Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: 8/23/2010
Accepted: 10/4/2010
Published online: 11/2/2010

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 4

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: http://www.karger.com/AJN


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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