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Selected research from leading health care experts whose findings have a direct bearing on public policies effecting medical progress. Research is chosen based on its quality and relevance by the Medical Progress Today editorial staff.

Selected Research

Elderly Not Adherent to Concomitant Antihypertensive and Lipid-Lowering Therapy
Medscape, 5-10-06

Controlling the progression of expensive diseases with inexpensive treatments—for instance, using statin drugs to lower a patient's high cholesterol in order to prevent a heart attack—is one of the ways that modern medicine can help lower the total cost of health care. This assumes, of course, that existing treatments to control disease are being used effectively by patients who can most benefit from them. Unfortunately, recent studies suggest that many of the patients most at risk for high–cost complications from diabetes or heart disease are using disease management treatments sporadically or improperly even when they are prescribed. This study, for instance, reported data showing that:

...only 32.9% [of elderly patients] took concomitant antihypertensive and lipid-lowering medication as prescribed.

"This study emphasizes the importance of considering adherence when caring for high-risk older patients," Dr. Richard H. Chapman commented to Reuters Health. "Despite the relatively high cardiovascular risk of these patients with both hypertension and dyslipidemia, surprisingly few patients were adherent to prescribed medications." … Patients took more of one class of drug or the other, with an additional 27.8% to 35.0% adherent to one medication at each time point over the estimates of adherence for both. Adherence to antihypertensive therapy was higher than with statin therapy.

"From the data in this study we cannot say why adherence was lower with lipid-lowering agents," Dr. Chapman said. "Such differences could be due to differences in side effects or other factors... For example, patients may believe that their high blood pressure is more of a problem than their high cholesterol." However, "we have no way to tell this for sure from this study."

The researchers found that if both drugs were prescribed at the same time, adherence to both was higher, with an adjusted odds ratio of 1.13. Patients with existing heart disease were more motivated to take medications as prescribed, with an adjusted odds ratio of 1.27 for adherence to both.

Until we have better tools to monitor high-risk patients and help them use pharmaceuticals effectively, our attempts to control health care costs through preventative medicine will lack in effectiveness.



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