Failing to Take Blood Pressure Drugs Puts 5 Million Seniors at Risk of Death

Failing to Take Blood Pressure Drugs Puts 5 Million Seniors at Risk of Death
A man monitors his blood pressure using a cuff and a smartphone. Photo courtesy Nofal.

High blood pressure is one of the biggest risk factors for heart disease, so controlling their blood pressure is one of the best ways for patients to stay heart healthy. Despite the benefits of blood pressure drugs, a new report has found that almost 5 million seniors on Medicare are failing to take their medicine, putting them at risk of death from cardiovascular disease.

The report comes from researchers at the United States Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). The organizations published their findings in the Morbidity and Mortality Weekly Report September 13th. Because of the importance of taking hypertension drugs, the researchers looked into how many patients are actually taking their drugs as prescribed to treat their high blood pressure.

For their study, the researchers looked at data from the CMS Chronic Conditions Data Warehouse, including administrative and prescription drug information for beneficiaries of Medicare Part D in 2014. This U.S. Medicare program helps seniors, over the age of 65, better afford their medication. Of the 30 million Medicare Part D beneficiaries, 19.5 million seniors were included in the study who were taking at least one hypertension drug in 2014 and who were not in an institution such as a nursing home. The hypertension drugs included in the study included beta blockers, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, calcium channel blockers, and diuretics.

The researchers wanted to look at medication adherence among these hypertension patients, which refers to the patients taking the drugs they were prescribed, as directed by their doctor. To measure nonadherence, the researchers looked at how many days the patients had a prescription for the drug versus how many days the patients actually took the drug.

When the researchers crunched the numbers, they discovered that 26.3 percent of hypertension patients on Medicare Part D were nonadherent. That means that 4.9 million Americans were not taking the drugs they needed to keep their high blood pressure, hypertension, under control. There were differences between ethnic groups as well, with American Indians, blacks, and Hispanics facing the lowest medication adherence. Nodadherence also tended to be higher when the patient was older and when they were taking more than one class of hypertension drug.

The study also found regional differences in medication adherence. Residents of North Dakota, Wisconsin, and Minnesota tended to stick with their drug regimen the best, at 18.7 percent to 18.9 percent nonadherence rates, respectively. Residents of Louisiana, Mississippi, and Washington, D.C. tended to have the highest rates of nonadherence, at 31.5 to 33.7 percent, respectively. Things were even worse in the territories of Puerto Rico and the U.S. Virgin Islands, with 39.6 percent and 46.9 percent nonadherence respectively.

In 2014 alone, these Medicare Part D patients filled 215.9 million hypertension drug prescriptions, worth a total of $5.9 billion. Of this, the Medicare beneficiaries covered 35.6 percent of the cost, which totals $2.1 billion out-of-pocket spending by these seniors. On average, the patients spent $92 a year on their hypertension drugs, but this varied greatly from patient to patient. Patients taking angiotensin II receptor blockers spent $476 per year on average, and patients taking four or more different antihypertensive drugs at a time spent an average of $693 per year. Most of the patients opted for generic versions of the drugs.

Hypertension drug adherence can make a huge difference on a patient’s health, giving them a 45 percent greater chance of keeping their blood pressure in check and decreasing their risk for a cardiovascular event, such as a heart attack or stroke, by 38 percent. Nonadherence to prescriptions can lead to poorer health and increased health care costs. Despite the benefits, this study demonstrates that about one in every four seniors fails to stick to their drug regimen. The question is why.

Although the report did not look into the reasons why the patients were nonadherent, there are a few reasons patients may not take their drugs as prescribed. Some patients may be taking multiple drugs and become confused about which drugs to take when, and other patients may forget to take their drugs or refill their prescription. Some patients may stop taking their drugs when their symptoms go away and some may avoid taking their drugs because of unpleasant side effects. However, another reason patients may not fill their prescriptions is because of the cost. Even with Medicare or insurance coverage, patients may have to pay much of their prescription cost out-of pocket. When on a budget and choosing between spending money on blood pressure drugs or on groceries or rent, seniors may avoid filling their prescription.

The CDC suggests doctors, pharmacists, and others can help increase prescription adherence in their hypertension patients. Doctors should try and make the drug regimens as simple as possible and explain to the patients how and why they should take their drugs. The doctors should also monitor whether their patients are actually taking their drugs as directed and encourage the use of at-home blood pressure monitors. Pharmacists should also reinforce how and why the patients should take their medication at every visit, check their blood pressure at the pharmacy, and offer compliance packaging which organizes drugs according to when patients should take them. Other people, such as community health workers or family, can check in on patients to see if they are taking their prescriptions and how their blood pressure readings are going. With about 70 percent of seniors experiencing high blood pressure, encouraging prescription adherence can have a huge impact on improving senior health and reducing health care costs.

Hypertension, or high blood pressure, is when blood is exerting too much force on blood vessel walls. This high pressure can damage blood vessels and organs, potentially leading to heart attack, stroke, or kidney failure. To help control their blood pressure, patients can take antihypertensive drugs, quit smoking, improve their diet, and get more exercise.

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