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Adherence to Antihypertensive Drugs Dropped During COVID-19 Shutdowns

Not surprisingly, COVID-19 shutdowns early in the pandemic had an effect on medication adherence. A new study looked at how well patients followed drug regimens for antihypertensives during that time period and made some discoveries that could help improve adherence even without sheltering-in-place orders. Here are more details.

GREENVILLE, SC – Shutdowns related to the COVID-19 pandemic adversely affected adherence to antihypertensive medication and especially had an effect on patients who already were at risk for not following medication regimens.

That’s according to a new study in JAMA Network Open which asked whether baseline antihypertensive medication adherence can help pinpoint those who are at risk for poor adherence during sheltering in place for COVID-19.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799724

Using a random sample of 27, 318 U.S. adults. American Medical Association researchers assessed antihypertensive medication adherence as the proportion of days covered (PDC) from filled prescriptions claims for 6 months before and after COVID-19 sheltering guidance. The study tracked adherence from Sept. 15, 2019, to March 14, 2020 [baseline]) compared with the first (March 15 to June 14, 2020) and second (June 15 to Sept. 14, 2020) 3 months of sheltering. Results indicate that poor adherence (PDC < 50) during sheltering occurred in 73% with poor baseline adherence, 32% with fair baseline adherence (PDC 50-79), and 10% with good baseline adherence (PDC ≥ 80).

“These findings suggest that adherence-promoting interventions may be useful irrespective of sheltering for poor baseline adherence and during sheltering for fair baseline adherence,” the authors note.

Participants in the retrospective cohort study were from EagleForce Health, a division of EagleForce Associates Inc. About half of the adults were aged 40 to 64 years, with the rest 65 to 90 years. They had prescription drug coverage, hypertension, and at least 1 antihypertensive medication prescription filled at a retail pharmacy during baseline.

Researchers used prescription claims to assess (1) PDC at baseline and changes in PDC during the first and second 3 months of sheltering and (2) the association of good (PDC ≥ 80), fair (PDC 50-79), and poor (PDC < 50) baseline adherence with adherence during sheltering.

Specifically, the authors report that mean PDC declined from baseline (65.6 [95% CI, 65.2-65.9]) during the first (63.4 [95% CI, 63.0-63.8]) and second (58.9 [95% CI, 58.5-59.3]) 3 months after sheltering in all adults combined (P < .001 for both comparisons) and both age groups separately. At the same time, good, fair, and poor baseline adherence was observed in 40.0%, 27.8%, and 32.2% of adults, respectively.

“During the last 3 months of sheltering, PDC declined more from baseline in those with good compared with fair baseline adherence (−13.1 [95% CI, −13.6 to −12.6] vs −8.3 [95% CI, −13.6 to −12.6]; P < .001), whereas mean (SD) PDC increased in those with poor baseline adherence (mean PDC, 31.6 [95% CI, 31.3-31.9] vs 34.4 [95% CI, 33.8-35.0]; P < .001),” the study states. “However, poor adherence during sheltering occurred in 1034 adults (9.5%) with good baseline adherence, 2395 (31.6%) with fair baseline adherence, and 6409 (72.9%) with poor baseline adherence.”

Researchers suggest their findings on patients with poor baseline adherence could result in adherence-promoting interventions even without sheltering guidance. “Interventions to prevent poor adherence during sheltering may be more useful for individuals with fair vs good baseline adherence,” they add.

Background information in the article recounts how concerns were raised that access to medications would be limited because of the closure of some pharmacies, shelter-in-place orders and social distancing recommendations. After an initial surge in mid-March 2020, weekly fill rates for the 2 most often obtained antihypertensive medications in the United States, lisinopril and amlodipine, fell roughly 14% and 8%, respectively, in mid-April, it adds.

“The 6–percentage point decline in hypertension control during 2020 from levels in 2018 and 2019 was clinically significant, yet many adults with hypertension apparently took sufficient medication to maintain control,” according to the researchers, who added, “ Prior adherence to medications for chronic conditions is almost always a better method of assessment than multivariable models without prior adherence and improves minimally with inclusion of other variables.”