Open AccessHierarchical Modeling of Patient and Physician Determinants of Blood Pressure Outcomes in Adherent vs Nonadherent Hypertensive Patients: Pooled Analysis of 6 Studies With 14,646 Evaluable Patients
Author(s) -
Abraham Ivo,
Camp Yoleen,
Villa Lorenzo,
Denhaerynck Kris,
Sun Diana,
Vancayzeele Stefaan,
Brié Heidi,
Aerts Ann,
Hermans Christine,
MacDonald Karen
Publication year - 2013
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12163
Subject(s) - medicine , blood pressure , logistic regression , valsartan
The authors used pooled data from 6 valsartan‐related studies including 3983 adherent and 10,663 nonadherent patients to evaluate blood pressure ( BP ) outcomes in both groups after 90 days of treatment, applying hierarchical linear and logistic regression to identify determinants of BP outcomes. The principal findings were that: (1) BP outcomes were consistently better in adherent patients; (2) approximately a quarter of the variance in 90‐day BP values was attributable to a physician class effect; (3) common and unique patient‐ and physician‐related variables were associated with BP outcomes in both groups; (4) physician vigilance was associated with better outcomes, especially in adherent patients; and (5) adherent patients were more likely to exhibit target organ damage and associated events while being prescribed more complex medication regimens. Adherence to antihypertensive medication may be a function of prior line treatment failure, severity of illness, and sequelae, and the ensuing patient resolution to change medication behavior.