Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial)
Background Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self‐reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear. Meth...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031574 |
| _version_ | 1797296293551276032 |
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| author | Joshua A. Jacobs Catherine G. Derington Alexander R. Zheutlin Jordan B. King Jordana B. Cohen John Bucheit Ian M. Kronish Daniel K. Addo Donald E. Morisky Tom H. Greene Adam P. Bress |
| author_facet | Joshua A. Jacobs Catherine G. Derington Alexander R. Zheutlin Jordan B. King Jordana B. Cohen John Bucheit Ian M. Kronish Daniel K. Addo Donald E. Morisky Tom H. Greene Adam P. Bress |
| author_sort | Joshua A. Jacobs |
| collection | DOAJ |
| description | Background Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self‐reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear. Methods and Results Cross‐sectional analysis was performed of the 12‐month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals. TI was defined as no increase in antihypertensive regimen intensity score, which incorporates medication number and dose, when systolic BP is ≥120 mm Hg. Self‐reported adherence was assessed using the 8‐Item Morisky Medication Adherence Scale (MMAS‐8) and categorized as low (MMAS‐8 score <6), medium (MMAS‐8 score 6 to <8), and high (MMAS‐8 score 8). Poisson regressions estimated prevalence ratios (PRs) and 95% CIs for TI associated with MMAS‐8. Among 1009 intensive arm participants with systolic BP >120 mm Hg at the 12‐month visit (mean age, 69.6 years; 35.2% female, 28.8% non‐Hispanic Black), TI occurred in 50.8% of participants. Participants with low adherence (versus high) were younger and more likely to be non‐Hispanic Black or smokers. The prevalence of TI among patients with low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (versus high) were associated with TI (PR, 1.11 [95% CI, 0.87–1.42]; PR, 1.08 [95% CI, 0.84–1.38], respectively). Conclusions Although clinician uncertainty about adherence is often cited as a reason for why antihypertensive intensification is withheld when above BP goals, we observed no evidence of an association between self‐reported adherence and TI. |
| first_indexed | 2024-03-07T22:02:32Z |
| format | Article |
| id | doaj.art-b98473bd543d4897bec98b968786a497 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:32Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b98473bd543d4897bec98b968786a4972024-02-24T04:06:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113310.1161/JAHA.123.031574Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial)Joshua A. Jacobs0Catherine G. Derington1Alexander R. Zheutlin2Jordan B. King3Jordana B. Cohen4John Bucheit5Ian M. Kronish6Daniel K. Addo7Donald E. Morisky8Tom H. Greene9Adam P. Bress10Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USAIntermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USADivision of Cardiology, Feinberg School of Medicine, Northwestern University Chicago IL USAIntermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USARenal‐Electrolyte and Hypertension Division, Perelman School of Medicine University of Pennsylvania Philadelphia PA USADepartment of Pharmacotherapy and Outcomes Science Virginia Commonwealth University School of Pharmacy Richmond VA USACenter for Behavioral Cardiovascular Health Columbia University Irving Medical Center New York NY USAIntermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USADepartment of Community Health Sciences UCLA Fielding School of Public Health Los Angeles CA USAIntermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USAIntermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine University of Utah Salt Lake City UT USABackground Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self‐reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear. Methods and Results Cross‐sectional analysis was performed of the 12‐month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals. TI was defined as no increase in antihypertensive regimen intensity score, which incorporates medication number and dose, when systolic BP is ≥120 mm Hg. Self‐reported adherence was assessed using the 8‐Item Morisky Medication Adherence Scale (MMAS‐8) and categorized as low (MMAS‐8 score <6), medium (MMAS‐8 score 6 to <8), and high (MMAS‐8 score 8). Poisson regressions estimated prevalence ratios (PRs) and 95% CIs for TI associated with MMAS‐8. Among 1009 intensive arm participants with systolic BP >120 mm Hg at the 12‐month visit (mean age, 69.6 years; 35.2% female, 28.8% non‐Hispanic Black), TI occurred in 50.8% of participants. Participants with low adherence (versus high) were younger and more likely to be non‐Hispanic Black or smokers. The prevalence of TI among patients with low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (versus high) were associated with TI (PR, 1.11 [95% CI, 0.87–1.42]; PR, 1.08 [95% CI, 0.84–1.38], respectively). Conclusions Although clinician uncertainty about adherence is often cited as a reason for why antihypertensive intensification is withheld when above BP goals, we observed no evidence of an association between self‐reported adherence and TI.https://www.ahajournals.org/doi/10.1161/JAHA.123.031574adherenceblood pressureclinical practice patterncompliancehypertension |
| spellingShingle | Joshua A. Jacobs Catherine G. Derington Alexander R. Zheutlin Jordan B. King Jordana B. Cohen John Bucheit Ian M. Kronish Daniel K. Addo Donald E. Morisky Tom H. Greene Adam P. Bress Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adherence blood pressure clinical practice pattern compliance hypertension |
| title | Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) |
| title_full | Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) |
| title_fullStr | Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) |
| title_full_unstemmed | Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) |
| title_short | Association Between Self‐Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial) |
| title_sort | association between self reported medication adherence and therapeutic inertia in hypertension a secondary analysis of sprint systolic blood pressure intervention trial |
| topic | adherence blood pressure clinical practice pattern compliance hypertension |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031574 |
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