Hierarchical 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
Article first published online: 12 JUL 2013
©2013 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 15, Issue 9, pages 663–673, September 2013
How to Cite
J Clin Hypertens (Greenwich). 2013;15:663–673. ©2013 Wiley Periodicals, Inc.
- Issue published online: 3 SEP 2013
- Article first published online: 12 JUL 2013
- Manuscript Accepted: 3 JUN 2013
- Manuscript Revised: 22 MAY 2013
- Manuscript Received: 22 MAR 2013
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.