At least 50 million adult Americans have hypertension, an important modifiable risk factor for coronary heart disease, stroke and end-stage renal disease. Efficacious blood pressure lowering medications are available but low adherence to medication by older adults can lead to poor outcomes.The overall objective of the proposed prospective cohort study is to determine factors that are associated with reduced antihypertensive medication adherence among older adults (>=65 years). The factors to be investigated include psychosocial, behavioral, quality of life (QOL), health care system issues including copayment/benefit, knowledge, sexual function (SF), medication class, use of unconventional therapies/lifestyle modifications.and clinical factors. The impact of these factors will be assessed overall and by gender and race. We propose to conduct a prospective cohort study with 2,000 participants >= 65 years of age with diagnosed essential hypertension (HTN) in a managed care organization (MCO). This study is designed to have 80% statistical power to detect relative risks of less than 1.5 of medication adherence at baseline and less than 2.0 for transitioning from high to medium or medium to low adherence over 2 years of follow-up associated with demographic, behavioral, clinical and treatment factors. A random, race-and gender- stratified sample of HTN patients >=65 years enrolled in the Medicare Risk Product of a large southern MCO will be selected from all eligible participants. Patients will be followed prospectively for an average of 2 years and medication adherence, QOL , SF, demographic, treatment, socio-economic, knowledge, clinical and behavioral factors will be determined at baseline and during annual telephone-administered follow-up surveys. Chart abstraction at baseline and follow-up will be used to assess blood pressure control, cardiovascular outcomes and HTN severity. MCO computerized medical record system will be used toaccess data on HTN medications, cardiovascular outcomes, copayment/benefit and utilization. The primary outcome will be medication adherence at baseline and changes in medication adherence during follow-up. In addition, the impact of medication adherence at baseline on blood pressure control, QOL, utilization, and cardiovascular outcomes during follow-up will be examined. Results of this study will lay the groundwork for interventions to improve medication adherence and clinical outcomes in older adults with hypertension and will increase our understanding of factors contributing to therapeutic outcomes in the use of medications by these patients.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
3R01AG022536-04S1
Application #
7931095
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Stahl, Sidney M
Project Start
2005-09-01
Project End
2011-08-31
Budget Start
2009-09-30
Budget End
2011-08-31
Support Year
4
Fiscal Year
2009
Total Cost
$474,697
Indirect Cost
Name
Ochsner Clinic Foundation
Department
Type
DUNS #
077900207
City
New Orleans
State
LA
Country
United States
Zip Code
70121
Krousel-Wood, Marie; Holt, Elizabeth; Joyce, Cara et al. (2015) Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO). J Hypertens 33:412-20
Krousel-Wood, Marie (2015) Hypertension and Health Behaviors in Females Across the Lifespan. Am J Med Sci 350:36-41
Holt, Elizabeth W; Rung, Ariane L; Leon, Kyla A et al. (2014) Medication Adherence in Older Adults: A Qualitative Study. Educ Gerontol 40:198-211
Krousel-Wood, Marie; Joyce, Cara; Holt, Elizabeth W et al. (2013) Development and evaluation of a self-report tool to predict low pharmacy refill adherence in elderly patients with uncontrolled hypertension. Pharmacotherapy 33:798-811
Holt, Elizabeth; Joyce, Cara; Dornelles, Adriana et al. (2013) Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults. J Am Geriatr Soc 61:558-64
Muntner, Paul; Levitan, Emily B; Joyce, Cara et al. (2013) Association between antihypertensive medication adherence and visit-to-visit variability of blood pressure. J Clin Hypertens (Greenwich) 15:112-7
Holt, Elizabeth W; Muntner, Paul; Joyce, C et al. (2012) Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults. Am J Epidemiol 176 Suppl 7:S64-71
Muntner, Paul; Joyce, Cara; Holt, Elizabeth et al. (2011) Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale. Ann Pharmacother 45:569-75
Krousel-Wood, Marie; Joyce, Cara; Holt, Elizabeth et al. (2011) Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults. Hypertension 58:804-10
Muntner, Paul; Joyce, Cara; Levitan, Emily B et al. (2011) Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care. J Hypertens 29:2332-8

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