Non-compliance and inertia in hypertensive Spaniards at high cardiovascular risk: CUMPLE study

Abstract

Objective:

To assess non-compliance (NC) and therapeutic inertia (TI) after 6 months of follow-up in hypertensive patients with poorly controlled blood pressure and high cardiovascular risk.

Research design and methods:

Longitudinal, multicentre study; 3900 uncontrolled hypertensive patients were recruited from 585 primary healthcare centres. Tablets were counted during visits at baseline, 1, 3 and 6 months. A tablet count between 80–100% was considered as compliant. Multivariate logistic regression was performed to determine variables associated with NC and TI.

Results:

A total of 3636 patients completed, mean age was 64.8 (SD 10.8) years, 53.7% being male. After one month, 61.8% (60.2–63.4) had uncontrolled blood pressure, 39.5% (37.9–41.1) were NC and 52.3% (50.2–54.4) had TI. At the end of follow-up, uncontrolled blood pressure was 34.6% (33.1–36.1) (p < 0.05), NC was 46.8% (45.2–48.4) (p < 0.05) and TI was 34.2% (31.6–36.8) (p < 0.05). The variable associated with NC was greatest number of antihypertensive treatments (OR 1.09, 95% CI 1.05–1.13, p < 0.001), and variables associated with TI were least number of antihypertensive drugs (OR 0.88, 95% CI 0.84–0.98, p < 0.001) and least number of diseases suffered (OR 0.95, 95% CI 0.92–0.98, p = 0.002).

Limitations:

Due to the complexity of measuring compliance, we have to assume measurement bias.

Conclusions:

Among uncontrolled hypertensive patients, after completing 6 months follow-up, approximately one out of two patients were NC and one out of three physicians committed TI.

Keywords::

• Antihypertensive
• Compliance
• Medical adherence
• Primary healthcare
• Therapeutic inertia

Transparency

Declaration of funding

This study was funded by Boehringer-Ingelheim Laboratories.

Author contributions are as follows. Study conception and design: E.M.-C., V.F.G.-G., M.D.L.F.-V.W., J.F.-N., J.L.L.-C., J.J.C.-M., V.B.-G., D.O.-B. Acquisition of data: M.D.L.F.-V.W., J.F.-N., J.L.L.-C., N.M.-C., J.L.M.-D.P., J.J.C.-M. Analysis and interpretation of data: E.M.-C., V.F.G.G., J.F.-N., N.M.-C., J.L.M.-D.P., V.B.-G., S.P.M., C.C.-M., D.O.-B. Drafting of manuscript: E.M.-C., V.F.G.-G., S.P.M., C.C.-M., A.L.-P. Critical revision: E.M.-C., V.F.G.-G., C.C.-M., A.L.-P.

Declaration of financial/other relationships

E.M.-C., V.F.G.-G., M.D.L.F.-V.W., J.F.-N., J.L.L.-C., N.M.-C., J.L.M.-D.P., J.J.C.-M., V.B.-G., S.P.M., C.C.-M., D.O.-B., and A.L.-P. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank and acknowledge the contribution of the study centres and the selected investigators and thank participating patients.