Analysis of Medication Adherence and Influencing Factors in Patients With Treatment-Resistant Hypertension in South Korea: A Nationwide Retrospective Cohort Study
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Objectives: Given the elevated cardiovascular risk in patients with treatment-resistant hyperten sion (TRH), it is crucial to prioritize their management. We examined TRH prevalence, medication adherence (MA) to antihypertensive drugs among TRH patients, and factors influencing their MA. Methods: Using the Korean National Health Insurance Service-National Sample Cohort Database 2.2, we identified TRH patients in 2017. They were defined as hypertensive patients prescribed ≥4 antihypertensive drugs, including a diuretic, for at least one month, or 3 antihypertensive drugs, in cluding a diuretic, for at least one month without reaching the target blood pressure (BP). Two-year MA was measured in 2018–2019 using medication possession ratio (MPR). Logistic regression ana lyzed factors associated with MA of TRH patients, denoting “high” as MPR ≥80% and “low” as MPR <80%. Results: The prevalence of TRH among hypertensive patients was 8.42%. TRH patients ex hibited significantly higher MPR (90.8%) compared to general hypertensive patients (88.4%, p<0.05). Regression analysis revealed that higher MA was associated with individuals aged 60 or above, those concurrently taking two or more antihypertensive medications, those with prescriptions lasting more than 30 days on average, and those with peripheral artery disease, diabetes mellitus, or dyslipidemia. Conversely, lower MA was observed in individuals consuming alcohol ≥12 times per month and current smokers. Conclusion: TRH patients demonstrated a higher MA than general hypertensive patients. These findings suggest that improving BP control in patients with apparent TRH may require more effective treatment strategies beyond simply addressing MA.
Abstract
Objectives: Given the elevated cardiovascular risk in patients with treatment-resistant hyperten sion (TRH), it is crucial to prioritize their management. We examined TRH prevalence, medication adherence (MA) to antihypertensive drugs among TRH patients, and factors influencing their MA. Methods: Using the Korean National Health Insurance Service-National Sample Cohort Database 2.2, we identified TRH patients in 2017. They were defined as hypertensive patients prescribed ≥4 antihypertensive drugs, including a diuretic, for at least one month, or 3 antihypertensive drugs, in cluding a diuretic, for at least one month without reaching the target blood pressure (BP). Two-year MA was measured in 2018–2019 using medication possession ratio (MPR). Logistic regression ana lyzed factors associated with MA of TRH patients, denoting “high” as MPR ≥80% and “low” as MPR <80%. Results: The prevalence of TRH among hypertensive patients was 8.42%. TRH patients ex hibited significantly higher MPR (90.8%) compared to general hypertensive patients (88.4%, p<0.05). Regression analysis revealed that higher MA was associated with individuals aged 60 or above, those concurrently taking two or more antihypertensive medications, those with prescriptions lasting more than 30 days on average, and those with peripheral artery disease, diabetes mellitus, or dyslipidemia. Conversely, lower MA was observed in individuals consuming alcohol ≥12 times per month and current smokers. Conclusion: TRH patients demonstrated a higher MA than general hypertensive patients. These findings suggest that improving BP control in patients with apparent TRH may require more effective treatment strategies beyond simply addressing MA.