Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug;70(2):307-314.
doi: 10.1161/HYPERTENSIONAHA.117.09659. Epub 2017 Jun 26.

Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department

Candace D McNaughton  1 , Nancy J Brown  2 , Russell L Rothman  2 , Dandan Liu  2 , Edmond K Kabagambe  2 , Phillip D Levy  2 , Wesley H Self  2 , Alan B Storrow  2 , Sean P Collins  2 , Christianne L Roumie  2
Affiliations

Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department

Candace D McNaughton et al. Hypertension. 2017 Aug.

Abstract

Elevated blood pressure (BP) is common in the emergency department (ED), but the relationship between antihypertensive medication adherence and BP in the ED is unclear. This cross-sectional study tested the hypothesis that higher antihypertensive adherence is associated with lower systolic BP (SBP) in the ED among adults with hypertension who sought ED care at an academic hospital from July 2012 to April 2013. Biochemical assessment of antihypertensive adherence was performed using a mass spectrometry blood assay, and the primary outcome was average ED SBP. Analyses were stratified by number of prescribed antihypertensives (<3, ≥3) and adjusted for age, sex, race, insurance, literacy, numeracy, education, body mass index, and comorbidities. Among 85 patients prescribed ≥3 antihypertensives, mean SBP for adherent patients was 134.4 mm Hg (±26.1 mm Hg), and in adjusted analysis was -20.8 mm Hg (95% confidence interval, -34.2 to -7.4 mm Hg; P=0.003) different from nonadherent patients. Among 176 patients prescribed <3 antihypertensives, mean SBP was 135.5 mm Hg (±20.6 mm Hg) for adherent patients, with no difference by adherence in adjusted analysis (+2.9 mm Hg; 95% confidence interval, -4.7 to 10.5 mm Hg; P=0.45). Antihypertensive nonadherence identified by biochemical assessment was common and associated with higher SBP in the ED among patients who had a primary care provider and health insurance and who were prescribed ≥3 antihypertensives. Biochemical assessment of antihypertensives could help distinguish medication nonadherence from other contributors to elevated BP and identify target populations for intervention.

Keywords: blood pressure; emergency medical services; hypertension; literacy; mass spectrometry; medication adherence.

PubMed Disclaimer

Conflict of interest statement

DISCLOSURES

The authors have no relevant competing interests. A portion of the results were presented the American Heart Association’s High Blood Pressure Research Council meeting on September 14–17, 2015 in Washington D.C.

Figures

Figure 1
Figure 1
Mean systolic blood pressure by adherence, stratified by number of prescribed antihypertensive medications
Figure 2
Figure 2
Difference in mean ED SBP for patients classified as adherent vs. non-adherent and stratified by number of prescribed BP medications.* Adherence is shown by both the blood assay and Adherence to Refills and Medications Scale (ARMS). * The analysis demonstrates results of multivariable linear regression models of the difference in systolic blood pressure between patients who were adherent and non-adherent. All analyses were adjusted for age, pain, sex, race, health insurance, health literacy, numeracy, BMI, chronic renal insufficiency, comorbid conditions, and duration of hypertension diagnosis Abbreviations: ED, emergency department; BP, blood pressure; BMI, body mass index
Figure 3
Figure 3
Mean systolic blood pressure by 4-level measure of adherence, stratified by number of prescribed antihypertensive medications Abbreviations: BP, blood pressure; meds, medications; Adherence to Refills and Medications Scale, ARMS
See this image and copyright information in PMC

Comment in

References

    1. Writing Group M. Mozaffarian D, Benjamin EJ, Go AS, et al. American Heart Association Statistics C and Stroke Statistics S Executive Summary: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:447–454. - PubMed
    1. Wright JT, Jr, Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–2116. - PMC - PubMed
    1. Peterson AM, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm. 2003;60:657–665. - PubMed
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497. - PubMed
    1. Irvin MR, Shimbo D, Mann DM, Reynolds K, Krousel-Wood M, Limdi NA, Lackland DT, Calhoun DA, Oparil S, Muntner P. Prevalence and correlates of low medication adherence in apparent treatment-resistant hypertension. J Clin Hypertens (Greenwich) 2012;14:694–700. - PMC - PubMed

Publication types

MeSH terms