Antihypertensives Adherence Trajectories and the Association Between Antihypertensive Medications and Fractures Among Older Adults Initiating Therapy Public Deposited

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  • March 20, 2019
  • Hargrove, Jennifer
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Antihypertensive medications reduce the risk of cardiovascular diseases among hypertensive patients. Yet, few older adults are adherent to their antihypertensive therapy. Failure to remain adherent can lead to increased risk of cardiovascular disease, hospitalizations, and mortality. Prior studies have relied on adherence measures that fail to distinguish between medication adherence and persistence. Furthermore, research suggests that antihypertensives are associated with fractures among older adults. However, prior research has found inconsistent results regarding the strength and direction of the association between antihypertensives and fractures. Few studies have examined the initial increased risk of fractures associated with starting antihypertensive therapy, and how the association between antihypertensive and fractures may change over time. We used a 20% random sample of 2007-2013 Medicare Fee-For-Service data to identify beneficiaries initiating antihypertensive therapy between 2008 and 2011. Our primary objectives were: 1) examine whether group based trajectory models (GBTMs) could be used to identify antihypertensive adherence trajectories among older adults initiating therapy, and 2) examine the association between antihypertensive initiation and fractures according to antihypertensive class, duration of use, and fracture type. In our first aim we found that antihypertensive adherence trajectories vary among Medicare beneficiaries and that GBTMs are an effective tool for capturing antihypertensive adherence. We identified six adherence trajectories ranging from beneficiaries who were fully adherent to beneficiaries who never returned after their first prescription. Compared to traditional adherence measures, GBTMs were better at identifying beneficiaries with fluctuating patterns of use. The strongest predictors of non-adherence included initiation with a single antihypertensive class, non-White race, and no prior history of cardiovascular disease. In our second aim we found that the association between antihypertensives and fractures varied according to antihypertensive class, time since initiation, and outcome definition (e.g., falls vs. fractures). Overall, beneficiaries who initiated with angiotensin-receptor blockers had the lowest rate of fractures in the year following initiation. Thiazides were associated with an initial increased rate of falls and fractures, but this association decreased over time. Results suggest clinicians may want to consider different fracture risks when choosing between antihypertensive drug classes, particularly for older adults with a history of falls or fractures.
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  • In Copyright
  • Marshall, Stephen
  • Loehr, Laura
  • Casteel, Carri
  • Stürmer, Til
  • Golightly, Yvonne
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017

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