Antihypertensive medication adherence and subsequent healthcare utilization and costs

Am J Manag Care. 2010 Aug;16(8):568-76.


Objectives: To evaluate the relationship between adherence to antihypertensive medications (AHMs) and subsequent hospitalizations, emergency department (ED) visits, and costs of care.

Study design: Retrospective analysis of a national pharmacy benefits database of deidentified pharmacy and medical claims among patients with a diagnosis of hypertension. Adherence was estimated using the medication possession ratio (MPR).

Methods: Multivariate logistic and 2-part general linear models were estimated to study the relationship between adherence level (estimated by the MPR) and subsequent association with healthcare costs and cardiovascular (CV)-related hospitalizations and ED visits.

Results: We identified 625,620 patients with at least 2 claims for AHMs and divided them into 3 cohorts based on year 1 MPR of less than 60% (62,388 patients with low adherence), 60% to 79% (96,226 patients with moderate adherence), and 80% or higher (467,006 patients with high adherence). Patients with high adherence to AHMs were more likely to be older and male, have higher chronic disease scores and lower AHM copayments, and fill a greater percentage of prescriptions by mail order. Year 2 total mean (SD) adjusted healthcare costs were significantly lower for patients with an MPR of 80% or higher ($7182 [$27]) vs 60% to 79% ($7560 [$59]) or less than 60% ($7995 [$73]) (P <.001 for both). In addition, patients with low or moderate adherence had higher age- and sex-adjusted odds of CV-related hospitalizations (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.25-1.41) and ED visits (OR, 1.45; 95% CI, 1.33-1.58) (P <.001 for both).

Conclusion: Adherence to AHMs is associated with significantly lower total healthcare costs and with significantly lower odds of CV-related hospitalizations and ED visits.

MeSH terms

  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use*
  • Confidence Intervals
  • Databases, Factual
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Services / economics
  • Health Services / statistics & numerical data*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / economics
  • Insurance Claim Review / statistics & numerical data
  • Logistic Models
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Retrospective Studies
  • United States


  • Antihypertensive Agents