Skip to main content
SpringerLink
Log in

Pre-stroke Adherence to Hypertension Medications in a Bi-racial United States Stroke Belt

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Introduction

Blood pressure is not optimally reduced in 3 of 4 patients with hypertension (HTN) in the United States.

Aim

We analyzed for factors associations with premorbid non-adherence to HTN medications in acute stroke patients.

Methods

This cross-sectional study included 225 acute stroke patients with self-reported adherence to HTM medications in a stroke registry in the Southeastern United States. We defined medication non-adherence as < 90% of prescribed. Logistic regression analyzed demographic and socioeconomic factors for prediction of adherence.

Results

There were 145 (64%) patients with adherence and 80 (36%) with non-adherence. The likelihood of adherence to HTN medications was decreased among black patients, OR 0.49 (95% CI 0.26–0.93), p = 0.03, and those without health insurance, OR 0.29 (95% CI 0.13–0.64), p = 0.002. Specific reasons for non-adherence were high medication cost in 26 (33%), side effects in 8 (10%), and other unspecified reasons in 46 (58%) patients.

Conclusion

In this study, adherence to HTN medications was significantly lower among black patients and those without health insurance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The data used in this study will be made available from the senior author upon reasonable request.

References

  1. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief. 2020;364:1–8.

    Google Scholar 

  2. Ritchey MD, Gillespie C, Wozniak G, Shay CM, Thompson-Paul AM, Loustalot F, Hong Y. Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline. J Clin Hypertens (Greenwich). 2018;20(10):1377–91. https://doi.org/10.1111/jch.13364.

    Article  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention (CDC). Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010. MMWR Morb Mortal Wkly Rep. 2012;61:703–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22951452

  4. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002;162(4):413–20. https://doi.org/10.1001/archinte.162.4.413.

    Article  PubMed  Google Scholar 

  5. Hill MN, Miller NH, Degeest S, Materson BJ, Black HR, Izzo JL, Oparil S, Weber MA. Adherence and persistence with taking medication to control high blood pressure. J Am Soc Hypertens. 2011;5(1):56–63. https://doi.org/10.1016/j.jash.2011.01.001.

    Article  PubMed  Google Scholar 

  6. Hyre AD, Krousel-Wood MA, Muntner P, Kawasaki L, DeSalvo KB. Prevalence and predictors of poor antihypertensive medication adherence in an urban health clinic setting. J Clin Hypertens (Greenwich). 2007;9(3):179–86. https://doi.org/10.1111/j.1524-6175.2007.06372.x.

    Article  PubMed  Google Scholar 

  7. Holt EW, Muntner P, Joyce CJ, Webber L, Krousel-Wood MA. Health-related quality of life and antihypertensive medication adherence among older adults. Age Ageing. 2010;39(4):481–7. https://doi.org/10.1093/ageing/afq040.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Krousel-Wood M, Craig LS, Peacock E, Zlotnick E, O’Connell S, Bradford D, Shi L, Petty R. Medication adherence: expanding the conceptual framework. Am J Hypertens. 2021;34(9):895–909. https://doi.org/10.1093/ajh/hpab046.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Terman SW, Kerr WT, Aubert CE, Hill CE, Marcum ZA, Burke JF. Adherence to antiseizure vs other medications among US medicare beneficiaries with and without epilepsy. Neurology. 2021;98(4):e427–36. https://doi.org/10.1212/WNL.0000000000013119.

    Article  PubMed  Google Scholar 

  10. Bruno A, Brooks DD, Abrams TA, Poorak MD, Gunio D, Kandhal PK, Lakhanpal A, Nagabandi AK, Akinwuntan AE, Looney S, Schafer PE. Left ventricular hypertrophy in acute stroke patients with known hypertension. Clin Exp Hypertens [Internet]. 2017;39:502–504. Available from: https://www.tandfonline.com/doi/full/https://doi.org/10.1080/10641963.2016.1259328

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. doi: https://doi.org/10.1016/j.jclinepi.2007.11.008

  12. Mochari H, Ferris A, Adigopula S, Henry G, Mosca L. Cardiovascular disease knowledge, medication adherence, and barriers to preventive action in a minority population. Prev Cardiol. 2007;10(4):190–5. https://doi.org/10.1111/j.1520-037x.2007.06619.x.

    Article  PubMed  Google Scholar 

  13. Marcum ZA, Zheng Y, Perera S, Strotmeyer E, Newman AB, Simonsick EM, Shorr RI, Bauer DC, Donohue JM, Hanlon JT. Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Res Social Adm Pharm. 2013;9(6):817–27. https://doi.org/10.1016/j.sapharm.2012.12.002.

    Article  PubMed  Google Scholar 

  14. Morgan SG, Lee A. Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries. BMJ Open. 2017;7(1): e014287. https://doi.org/10.1136/bmjopen-2016-014287.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chang SM, Lu IC, Chen YC, Hsuan CF, Lin YJ, Chuang HY. Behavioral factors associated with medication nonadherence in patients with hypertension. Int J Environ Res Public Health. 2021;18(18):9614. https://doi.org/10.3390/ijerph18189614.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yassine M, Al-Hajje A, Awada S, Rachidi S, Zein S, Bawab W, Bou Zeid M, El Hajj M, Salameh P. Evaluation of medication adherence in Lebanese hypertensive patients. J Epidemiol Glob Health. 2016;6(3):157–67. https://doi.org/10.1016/j.jegh.2015.07.002.

    Article  PubMed  Google Scholar 

Download references

Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA

    Askiel Bruno

  2. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA

    Jayachandra Muppa

  3. Medical College of Georgia, Augusta, GA, USA

    Iagn Niño Kenji Cabahug

Authors
  1. Askiel Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jayachandra Muppa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iagn Niño Kenji Cabahug
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jayachandra Muppa.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest regarding this study.

Ethical approval

This study was approved by the Augusta University Institutional Review Board.

Informed consent

All patients who contributed data to this study signed a valid informed consent.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bruno, A., Muppa, J. & Cabahug, I.N.K. Pre-stroke Adherence to Hypertension Medications in a Bi-racial United States Stroke Belt. High Blood Press Cardiovasc Prev 30, 333–336 (2023). https://doi.org/10.1007/s40292-023-00581-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-023-00581-6

Keywords

Search

Navigation