Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study
Aim: Non-adherence is an important cause of uncontrolled hypertension. We investigated the prevalence of non-adherence to antihypertensive medications by serum drug concentration measurements in a cohort of Norwegian patients from the general population treated for hypertension. We also identified c...
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Open Exploration Publishing Inc.
2025-02-01
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| author | Eirik Olsen Lene V. Halvorsen Stine Rognstad Arleen Aune Karl Marius Brobak Ola Undrum Bergland Vibeke N. Kjær Knut Liestøl Marit D. Solbu Rune Mo Eva Gerdts Morten Rostrup Sverre E. Kjeldsen Aud Høieggen Mimi S. Opdal Anne Cecilie K. Larstorp Camilla L. Søraas |
| author_facet | Eirik Olsen Lene V. Halvorsen Stine Rognstad Arleen Aune Karl Marius Brobak Ola Undrum Bergland Vibeke N. Kjær Knut Liestøl Marit D. Solbu Rune Mo Eva Gerdts Morten Rostrup Sverre E. Kjeldsen Aud Høieggen Mimi S. Opdal Anne Cecilie K. Larstorp Camilla L. Søraas |
| author_sort | Eirik Olsen |
| collection | DOAJ |
| description | Aim: Non-adherence is an important cause of uncontrolled hypertension. We investigated the prevalence of non-adherence to antihypertensive medications by serum drug concentration measurements in a cohort of Norwegian patients from the general population treated for hypertension. We also identified characteristics associated with non-adherence. Methods: Patients with hypertension using ≥ 2 antihypertensive agents were invited to participate in this national study performed in a semi-blinded fashion. Exclusion criteria were dementia, substance or alcohol abuse, pregnancy, terminal illnesses, poor Norwegian language skills, or severe kidney failure [glomerular filtration rate (GFR) < 30 mL/min/1.73 m2]. All patients had their antihypertensive drugs in serum analyzed by ultra-high-pressure liquid chromatography-tandem mass spectrometry to identify their adherence to the 23 most used antihypertensive agents. Additionally, they underwent a thorough standardized interview, office blood pressure (BP), and 24-hour ambulatory BP measurement. Results: n = 1,151 patients were investigated for BP control and drug adherence. Among these, n = 79 (6.9%) patients were identified as non-adherent, and n = 1,072 (93.1%) patients were identified as adherent by pharmacologists who reviewed the drug concentrations in blood in relation to self-reported prescribed medications. We found the non-adherent patients to be younger (56.9 vs. 63.7 years, p < 0.001), with higher systolic and diastolic office BP (150.4/91.4 vs. 143.2/82.0 mmHg, p < 0.01) and less likely to be of European ethnicity (82.9% vs. 95.8%, p < 0.001). Factors associated with non-adherence in logistic regression analysis were age, number of antihypertensive pills, non-European ethnicity, and inversely the use of angiotensin receptor blockers. Conclusions: We found fewer non-adherent patients than expected in patients on ≥ 2 antihypertensive drugs compared to previous investigations of patients on ≥ 3 antihypertensive drugs. We believe that selection at inclusion or possibly a higher confidence in physicians’ authority may be of importance. Adherence was significantly and negatively related to younger age, non-European ethnicity, and increasing number of prescribed antihypertensive pills, and positively to the type of prescribed medication, especially angiotensin receptor blocker (www.ClinicalTrials.gov identifier: NCT03209154). |
| format | Article |
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| language | English |
| publishDate | 2025-02-01 |
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| spelling | doaj-art-f35e80da443741939e70acb20758df932025-02-08T05:26:23ZengOpen Exploration Publishing Inc.Exploration of Medicine2692-31062025-02-016100127910.37349/emed.2025.1001279Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional studyEirik Olsen0https://orcid.org/0009-0008-6187-658XLene V. Halvorsen1https://orcid.org/0000-0003-0411-2459Stine Rognstad2Arleen Aune3https://orcid.org/0000-0002-6363-9819Karl Marius Brobak4https://orcid.org/0000-0001-7104-1764Ola Undrum Bergland5Vibeke N. Kjær6Knut Liestøl7https://orcid.org/0000-0002-7929-582XMarit D. Solbu8https://orcid.org/0000-0002-4331-7548Rune Mo9Eva Gerdts10Morten Rostrup11Sverre E. Kjeldsen12https://orcid.org/0000-0003-2389-0272Aud Høieggen13Mimi S. Opdal14https://orcid.org/0000-0002-7011-9811Anne Cecilie K. Larstorp15https://orcid.org/0000-0002-0223-9248Camilla L. Søraas16https://orcid.org/0000-0002-3964-4351Norwegian University of Science and Technology, 7030 Trondheim, Norway; Department of Cardiology, St. Olav’s University Hospital, 7030 Trondheim, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Department of Nephrology, Ullevaal University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Department of Pharmacology, Ullevaal University Hospital, 0424 Oslo, NorwayDepartment of Clinical Science, University of Bergen, 5020 Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, 9037 Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, 9038 Tromsø, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, NorwayDepartment of Informatics, University of Oslo, 0316 Oslo, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, 9037 Tromsø, Norway; Section of Nephrology, University Hospital of North Norway, 9038 Tromsø, NorwayNorwegian University of Science and Technology, 7030 Trondheim, Norway; Department of Cardiology, St. Olav’s University Hospital, 7030 Trondheim, NorwayDepartment of Clinical Science, University of Bergen, 5020 Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Institute of Behavioral Sciences in Medicine, University of Oslo, 0316 Oslo, Norway; Department of Acute Medicine, Ullevaal University Hospital, 0424 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Department of Nephrology, Ullevaal University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Department of Cardiology, Ullevaal University Hospital, 0424 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Department of Nephrology, Ullevaal University Hospital, 0424 Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Department of Pharmacology, Ullevaal University Hospital, 0424 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Department of Medical Biochemistry, Ullevaal University Hospital, 0424 Oslo, NorwaySection for Cardiovascular and Renal Research, Ullevaal University Hospital, 0424 Oslo, Norway; Section for Environmental and Occupational Medicine, Ullevaal University Hospital, 0424 Oslo, NorwayAim: Non-adherence is an important cause of uncontrolled hypertension. We investigated the prevalence of non-adherence to antihypertensive medications by serum drug concentration measurements in a cohort of Norwegian patients from the general population treated for hypertension. We also identified characteristics associated with non-adherence. Methods: Patients with hypertension using ≥ 2 antihypertensive agents were invited to participate in this national study performed in a semi-blinded fashion. Exclusion criteria were dementia, substance or alcohol abuse, pregnancy, terminal illnesses, poor Norwegian language skills, or severe kidney failure [glomerular filtration rate (GFR) < 30 mL/min/1.73 m2]. All patients had their antihypertensive drugs in serum analyzed by ultra-high-pressure liquid chromatography-tandem mass spectrometry to identify their adherence to the 23 most used antihypertensive agents. Additionally, they underwent a thorough standardized interview, office blood pressure (BP), and 24-hour ambulatory BP measurement. Results: n = 1,151 patients were investigated for BP control and drug adherence. Among these, n = 79 (6.9%) patients were identified as non-adherent, and n = 1,072 (93.1%) patients were identified as adherent by pharmacologists who reviewed the drug concentrations in blood in relation to self-reported prescribed medications. We found the non-adherent patients to be younger (56.9 vs. 63.7 years, p < 0.001), with higher systolic and diastolic office BP (150.4/91.4 vs. 143.2/82.0 mmHg, p < 0.01) and less likely to be of European ethnicity (82.9% vs. 95.8%, p < 0.001). Factors associated with non-adherence in logistic regression analysis were age, number of antihypertensive pills, non-European ethnicity, and inversely the use of angiotensin receptor blockers. Conclusions: We found fewer non-adherent patients than expected in patients on ≥ 2 antihypertensive drugs compared to previous investigations of patients on ≥ 3 antihypertensive drugs. We believe that selection at inclusion or possibly a higher confidence in physicians’ authority may be of importance. Adherence was significantly and negatively related to younger age, non-European ethnicity, and increasing number of prescribed antihypertensive pills, and positively to the type of prescribed medication, especially angiotensin receptor blocker (www.ClinicalTrials.gov identifier: NCT03209154).https://www.explorationpub.com/uploads/Article/A1001279/1001279.pdfadherenceantihypertensive medicationblood pressurehypertension |
| spellingShingle | Eirik Olsen Lene V. Halvorsen Stine Rognstad Arleen Aune Karl Marius Brobak Ola Undrum Bergland Vibeke N. Kjær Knut Liestøl Marit D. Solbu Rune Mo Eva Gerdts Morten Rostrup Sverre E. Kjeldsen Aud Høieggen Mimi S. Opdal Anne Cecilie K. Larstorp Camilla L. Søraas Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study Exploration of Medicine adherence antihypertensive medication blood pressure hypertension |
| title | Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study |
| title_full | Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study |
| title_fullStr | Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study |
| title_full_unstemmed | Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study |
| title_short | Characteristics of adherent and non-adherent patients with hypertension in a Norwegian cross-sectional study |
| title_sort | characteristics of adherent and non adherent patients with hypertension in a norwegian cross sectional study |
| topic | adherence antihypertensive medication blood pressure hypertension |
| url | https://www.explorationpub.com/uploads/Article/A1001279/1001279.pdf |
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