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      Adherence to Antihypertensive Medications in Iranian Patients

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          Abstract

          Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP ( r = −0.231, P < 0.001) as well as diastolic BP ( r = −0.280, P < 0.001). In linear regression model, overweight/obesity ( B = −0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis ( B = −0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand ( B = −0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

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          Most cited references29

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          Predictive validity of a medication adherence measure in an outpatient setting.

          This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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            New medication adherence scale versus pharmacy fill rates in seniors with hypertension.

            To evaluate the association and concordance of the new 8-item self-report Morisky Medication Adherence Scale (MMAS) with pharmacy fill data in a sample of community-dwelling seniors with hypertension. Cross-sectional study. Pharmacy records for antihypertensive medications were abstracted for 87 managed care adult patients with hypertension 65 years and older who completed a survey that included the MMAS. Continuous single-interval medication availability (CSA), medication possession ratio (MPR), and continuous multiple-interval medication gaps (CMG) were calculated using pharmacy data. The MMAS adherence was categorized as high, medium, and low (MMAS scores of 8, 6 to <8, and <6, respectively); pharmacy fill nonpersistence was defined as less than 0.8 for CSA and MPR and as greater than 0.2 for CMG. Overall, 58%, 33%, and 9% of participants had high, medium, and low medication adherence, respectively, by the MMAS. After adjustment for demographics and in comparison to high adherers on the MMAS, patients with low MMAS adherence were 6.89 (95% confidence interval [CI], 2.48-19.10) times more likely to have nonpersistent pharmacy fill adherence by CSA and were 5.22 (95% CI, 1.88-14.50) times more likely to have nonpersistent pharmacy fill adherence by MPR. Concordance between the MMAS and CSA, MPR, and CMG was 75% or higher. The MMAS is significantly associated with antihypertensive drug pharmacy refill adherence. Although further validation of the MMAS is needed, it may be useful in identifying low medication adherers in clinical settings.
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              Improving the measurement of self-reported medication nonadherence: response to authors.

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                Author and article information

                Journal
                Int J Hypertens
                Int J Hypertens
                IJHY
                International Journal of Hypertension
                Hindawi Publishing Corporation
                2090-0384
                2090-0392
                2016
                16 March 2016
                : 2016
                : 1508752
                Affiliations
                1Islamic Azad University, Tehran Medical Branch, Tehran, Iran
                2Zanjan University of Medical Sciences, Zanjan, Iran
                3Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                4School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
                5Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
                Author notes

                Academic Editor: Tomohiro Katsuya

                Article
                10.1155/2016/1508752
                4812400
                27069676
                ded55665-61d4-461f-a617-128f3e678e6b
                Copyright © 2016 Azin Behnood-Rod et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 December 2015
                : 16 February 2016
                Categories
                Research Article

                Cardiovascular Medicine
                Cardiovascular Medicine

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