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Associate Professor, Pharmacy Practice Department, Texas Southern University, Houston, TX; Adjunct Assistant Professor of Medicine, Baylor College of Medicine, Houston; Clinical Pharmacy Specialist, Department of Pharmacy, Michael E DeBakey VA Medical Center, Houston
Pharmacoeconomic Research Specialist, Drug Use Policy and Pharmacoeconomics, Houston
Associate Professor, Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC; Associate Director, Hollings Cancer Center, Cancer Disparity Program, Charleston
Research Scientist and Staff Physician, Houston Center for Quality of Care & Utilization Studies, Sections of Geriatrics and Health Services Research, Michael E DeBakey VA Medical Center; Assistant Professor of Medicine and Medical Ethics, Baylor College of Medicine
Reprints: Dr. Poon, Texas Southern University, College of Pharmacy and Health Sciences, 3100 Cleburne St., Houston, TX 77004, fax 713/313-7965, chui_io{at}tsu.edu
BACKGROUND: Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored.
OBJECTIVE: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups.
METHODS: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis.
RESULTS: A total of 56,561 patients (70.5% white, 15.6% African
American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and
hypertension. African Americans were less likely than whites to receive
angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers
(ARBs), β-blockers, acetylcholinesterase inhibitors, and memantine (p
< 0.05). Hispanics were more likely than whites to be prescribed an ACE
inhibitor and less likely to be prescribed an ARB, β-blocker,
nondihydropyridine calcium-channel blocker (CCB), loop diuretic,
-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication
adherence was significantly lower in African Americans than whites in all
classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being
Hispanic was associated with significantly lower adherence rates than whites
for dihydropyridine CCBs and acetylcholinesterase inhibitors (p <
0.05).
CONCLUSIONS: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.
Key Words: aged, dementia, drug utilization, ethnic groups, hypertension, race
Published Online, February 3, 2009. www.theannals.com, DOI 10.1345/aph.1L368
This article has been cited by other articles:
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  C. J Maxwell and D. B Hogan Antihypertensive agents and prevention of dementia BMJ, January 12, 2010; 340(jan12_1): b5409 - b5409. [Full Text]
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