Blood Pressure Control Among Adherent vs Nonadherent Medicare Patients With Hypertension.

OBJECTIVES

Medication adherence measures for hypertension drive financial incentives and patient care strategies for many value-based health care programs. The association between medication adherence and hypertension control as a value-based quality measure is not well described. The objectives of this study were to compare blood pressure (BP) control among Medicare and Medicare Advantage patients who meet vs do not meet the medication adherence for hypertension (MAH) measure and compare patient and prescription factors associated with adherence vs disease control.

STUDY

DESIGN

Retrospective cohort study using linked payer and electronic health record data from a single health system.

METHODS

Medicare patients eligible for MAH in 2023 were categorized as adherent or nonadherent according to measure specifications, and hypertension control was defined as a primary care office BP less than 140/90 mm Hg or less than 130/80 mm Hg. Multivariable logistic regression was used to identify factors independently associated with adherence and disease control.

RESULTS

Of the 5206 patients evaluated, 77.9% were classified as adherent to the MAH measure. Of adherent patients, 77.2% achieved a BP less than 140/90 mm Hg vs 73.5% of nonadherent patients ( P  = .01), and 45.9% and 43.4%, respectively, achieved a BP of less than 130/80 mm Hg ( P  = .14). White race and younger age were positively associated with hypertension control, whereas extended days' supply and non-White race were associated with meeting the MAH measure.

CONCLUSIONS

Patients classified as adherent were more likely to achieve a BP less than 140/90 mm Hg, but achievement of BP less than 130/80 mm Hg did not differ between groups. A sizeable proportion of patients who did not meet the adherence measure (73.5%) achieved a BP less than 140/90 mm Hg. Factors associated with adherence vs disease control differed. Emphasis on disease control over medication adherence measures may more meaningfully reflect high-value clinical care.