Tuesday, February 12, 2008

Poor BP Control Tied to Medication Nonadherence & Therapy Intensification

Physician's First Watch for February 12, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief

Poor BP Control Tied to Medication Nonadherence & Therapy Intensification

Medication nonadherence explains why some patients with coronary artery disease have difficulty controlling their hypertension despite more intensive therapy, reports Archives of Internal Medicine.

In a retrospective study, over 10,000 patients with coronary disease were followed for a median of 4.6 years within a managed care organization.

After multivariable adjustment, the 5% of patients who had uncontrolled BP were more likely to have medication nonadherence (prescription fill rate <80%) and to have had increases in the dosage or number of antihypertensive drugs (respective odds ratios, 1.73 and 1.31), compared with patients who lowered their blood pressure.

Noting the cohort's "remarkably low" rate of uncontrolled hypertension, an editorialist points out that clinicians were aided by "a clinical pharmacy specialist-managed, physician-monitored disease management service." He writes: "The key to effective blood pressure control appears to have more to do with patient and physician information exchange (or lack thereof) than with biology or drug failure."

Archives of Internal Medicine article (Free abstract; full text requires subscription)
Archives of Internal Medicine editorial (Subscription required)Related Journal Watch link(s):
Journal Watch Cardiology summary (Free)

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