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Association Between Self-Reported Hypertension and Antihypertensive Medication Use and Cardiovascular Disease-Related
Madeleine M Baker-Goering1, David H Howard2, Julie C Will3
11 Policy Research Analysis and Development Office, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insights
Patients aware of their high blood pressure are more likely to fill prescriptions and less likely to experience cardiovascular disease (CVD) events. Improving hypertension awareness can enhance medication adherence and reduce CVD-related healthcare utilization.
Area of Science:
- Cardiovascular Disease Research
- Health Outcomes Research
- Public Health
Background:
- Awareness of cardiovascular disease (CVD) risk factors is linked to healthier behaviors.
- Hypertension is a significant risk factor for CVD.
- Understanding patient self-knowledge of hypertension is crucial for effective management.
Purpose of the Study:
- To investigate if patients with hypertension diagnosis who self-report high blood pressure are more likely to fill antihypertensive prescriptions.
- To determine if self-reported high blood pressure is associated with fewer CVD-related emergency department visits and hospitalizations.
- To analyze the impact of self-reported high blood pressure on medical expenditures related to CVD events.
Main Methods:
- Utilized a large US commercial insurance database (MarketScan) linked with Health Risk Assessment (HRA) data (2008-2012).
- Included 111,655 patients aged 18-64 with hypertension ICD-9 codes and completed HRAs.
- Employed multivariate logistic regression and a 2-part model to analyze medication adherence, CVD events, and expenditures.
Main Results:
- Patients self-reporting high blood pressure showed a significantly higher probability of filling antihypertensive prescriptions (26.5%).
- Self-reporting was associated with a significantly lower probability of CVD-related events (0.6%).
- These patients also incurred significantly lower average medical expenditures for CVD-related events ($251).
Conclusions:
- Self-knowledge of high blood pressure can be improved even in diagnosed and treated patients.
- Interventions enhancing patient awareness of hypertension may boost medication adherence.
- Improved awareness has the potential to reduce adverse cardiovascular disease events and associated healthcare costs.
Objectives:
Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure.
Methods:
We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures.
Results:
Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P < .001), had a significantly lower predicted probability of a CVD-related event (0.6%, P < .001), and on average spent significantly less on CVD-related events ($251, P = .01) than patients who did not self-report high blood pressure.
Conclusion:
This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients' awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events.
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