Adherence to Oral Medications for Hypertension and Diabetes in Veterans with Comorbid Airflow Limitation

摘要

Measurements and Main Results: Overall adherence was poor (44.6-55.1%). Among patients with hypertension, when compared with subjects with normal FEV_1; subjects with each category lower of FEV_1 were less adherent to p-blockers, with an odds ratio (OR) of 0.87 (95% confidence interval [CI], 0.80-0.95); calcium channel blockers, with an OR of 0.83 (95% CI, 0.74-0.93); and angiotensin-converting-enzyme inhibitors with an OR of 0.91 (95% CI, 0.84-0.99). Airflow limitation was not associated with adherence to thiazides. Among patients with diabetes, we found no significant association of FEV_1 with adherence, although a similar lower trend with increasing airflow limitation. In a sensitivity analysis limited to patients with chronic obstructive pulmonary disease, we found a nonstatistically significant trend for decreased adherence to beta-blockers, calcium channel blockers, and angiotensin-converting-enzyme inhibitors in subjects with higher GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage.Conclusions: Severity of airflow limitation is associated with decreased adherence to beta-blockers, calcium channel blockers, and angiotensin-converting-enzyme inhibitors. The decreased adherence to these medications maybe related to adverse effects on symptoms in patients with lung disease, and may partially explain excess CV mortality in these patients.