BACKGROUND: Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored. OBJECTIVE: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups. METHODS: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis. RESULTS: A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, beta-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, alpha-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05). CONCLUSIONS: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.
BACKGROUND:Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored. OBJECTIVE: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups. METHODS: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis. RESULTS: A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, beta-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, alpha-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05). CONCLUSIONS: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.
Authors: James B Wetmore; Milind A Phadnis; Jonathan D Mahnken; Edward F Ellerbeck; Sally K Rigler; Xinhua Zhou; Theresa I Shireman Journal: Clin J Am Soc Nephrol Date: 2014-01-23 Impact factor: 8.237
Authors: James B Wetmore; Jonathan D Mahnken; Sally K Rigler; Edward F Ellerbeck; Purna Mukhopadhyay; Qingjiang Hou; Theresa I Shireman Journal: Am J Hypertens Date: 2012-12-28 Impact factor: 2.689
Authors: James B Wetmore; Jonathan D Mahnken; Sally K Rigler; Edward F Ellerbeck; Purna Mukhopadhyay; Qingjiang Hou; Theresa I Shireman Journal: Am J Nephrol Date: 2012-06-27 Impact factor: 3.754
Authors: Jared R Tinklenberg; Helena C Kraemer; Kristine Yaffe; Ruth O'Hara; John M Ringman; John W Ashford; Jerome A Yesavage; Joy L Taylor Journal: Am J Geriatr Psychiatry Date: 2014-09-28 Impact factor: 4.105
Authors: Holly M Holmes; Ruili Luo; Joseph T Hanlon; Linda S Elting; Maria Suarez-Almazor; James S Goodwin Journal: J Am Geriatr Soc Date: 2012-06-15 Impact factor: 5.562