Nonpersistence and low adherence are common among younger adults initiating antihypertensive medications and have not improved over time, according to a study published in the issue of Hypertension.

Gabriel S. Tajeu, Dr.P.H., M.P.H., from Temple University in Philadelphia, and colleagues examined trends in antihypertensive medication nonpersistence and low adherence among 379,658 commercially insured adults aged <65 years initiating treatment in 2007 to 2014.

The researchers found that 23.3 and 23.5 percent of patients were nonpersistent with treatment in 2007 and 2014, respectively, and 42.3 and 40.2 percent had low adherence. Lower relative risks of nonpersistence and low adherence were seen for beneficiaries initiating treatment with an angiotensin-converting enzyme inhibitor (0.95 [95 percent confidence interval (CI), 0.94 to 0.97] and 0.97 [95 percent CI, 0.96 to 0.98], respectively), angiotensin receptor blocker (0.86 [95 percent CI, 0.85 to 0.88] and 0.99 [95 percent CI, 0.97 to 1.00], respectively), or multiclass regimen (0.82 [95 percent CI, 0.80 to 0.84] and 0.88 [95 percent CI, 0.86 to 0.89], respectively); relative risks were also lower with prescribed 90-day versus 30-day prescriptions (0.67 [95 percent CI, 0.66 to 0.68] and 0.70 [95 percent CI, 0.69 to 0.71], respectively) and for those receiving medications by mail versus at the pharmacy (0.93 [95 percent CI, 0.90 to 0.95] and 0.90 [95 percent CI, 0.88 to 0.92], respectively).

"The current analyses suggest some possible approaches to improving adherence," the authors write. "Given their association with lower rates of nonpersistence and low adherence, 90-day and mail order prescriptions should be promoted, and randomized controlled trials should be conducted to determine the impact of these scalable interventions on antihypertensive medication adherence."

Several authors disclosed financial ties to the pharmaceutical industry.

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