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Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension

Jennifer B Levin1, David J Moore2, Farren Briggs3

  • 1Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

International Journal of Psychiatry in Medicine
|September 14, 2024
PubMed

Insights

Medication adherence in bipolar disorder (BD) and hypertension (HTN) patients impacts health outcomes. Better adherence to BD medications correlated with higher psychiatric symptoms, while antihypertensive adherence improved blood pressure control.

Area of Science:

  • Psychiatry
  • Cardiology
  • Pharmacology

Background:

  • Individuals with bipolar disorder (BD) often experience poor medication adherence, leading to increased medical illness and premature mortality, particularly from cardiovascular causes.
  • Comorbid hypertension (HTN) in BD patients exacerbates these risks, highlighting the need to understand medication adherence in this population.

Purpose of the Study:

  • To examine the association between adherence to antihypertensive medications, adherence to BD medications, and clinical symptoms in patients with BD and comorbid HTN.
  • To investigate how different measurement methods impact the assessment of medication adherence.

Main Methods:

  • Included 83 participants with BD and HTN, assessing adherence via self-report (Tablets Routine Questionnaire) and electronic monitoring (eCAP).
  • Measured average systolic blood pressure (SBP) from 12 readings and BD symptoms using the Montgomery-Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS).

Main Results:

  • Adherence to BD medications and antihypertensives were positively correlated.
  • Electronic monitoring (eCAP) revealed more missed antihypertensive doses than self-reports.
  • Antihypertensive adherence correlated negatively with SBP, and this adherence improved while SBP decreased from screening to baseline.

Conclusions:

  • Medication adherence levels varied over time and by measurement method in patients with comorbid BD and HTN.
  • Self-reported BD medication adherence was linked to higher psychiatric symptom severity.
  • Antihypertensive adherence was associated with better SBP control, and monitoring both medication and blood pressure influenced self-reported adherence.
Abstract

Keywords:
adherence measurementcomorbiditymedical illnessmental illnesspsychiatric symptoms

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