5 ADHERENCE TO PHARMACOTHERAPY IN POSTMENOPAUSAL WOMEN AFFECTED BY HYPERTENSION OR METABOLIC SYMDROME: REAL WORLD EXPERIENCE
Authors: Maiello Maria , Amati Francesca , Ciccone Marco Matteo , Palmiero Pasquale 
Published: December 2022

Abstract

Objectives
The aim of our study is to assess the adherence to pharmacological therapy in two different setting of patients, referred to our Heart Stations by General Practitioners and to value the relationship between different levels of cardiovascular prevention and adherence. In our study, medication adherence was estimated by calculating the proportion of days covered (PDC) for all classes of drugs after the index date. The PDC calculation is made based on the fill dates and days supplied for each fill of a prescription and has been validated as a measure of medication adherence.

Methods
We enrolled 6833 consecutive postmenopausal women, menopause was diagnosed with cessation of menstruation for almost one year. 5857 were hypertensive (85.7%) and 976 (14.3%) were affected by metabolic syndrome (MetS) a cluster of risk factors associated with increased cardiovascular morbidity and mortality. Diagnosis of hypertension was performed according to 2018 European Guidelines for the treatment of high blood pressure and diagnosis of MetS was done according to the National Cholesterol Education Program Adult Treatment Panel III. Exclusion criteria were ventricular ejection fraction &lt; 45% and coronary, valvular and pericardial heart disease. All women were aged 50 to 69 years, data on age, sex, blood pressure and blood test results were collected at baseline. In our study, medication adherence was estimated by calculating the proportion of days covered (PDC) for all classes of drugs after the index date.

Results
Among 5857 postmenopausal hypertensive women 3752 were affected by hypertensive cardiomyopathy (64%). Among 976 postmenopausal with MetS 550 were affected by metabolic cardiomyopathy (56%). Non-adherent hypertensive women were 297 (5%) on 5857, non-adherent women with MetS were 73 (7.4%) on 976, Chi-squared 9.5, Odds ratio 1.5, c.i.95%, p&lt;0.02. Taking into consideration only women with cardiomyopathy non-adherent were 234 on 4302 (5.4%), while without cardiomyopathy non-adherent were 136 on 2531 (5.3%), Chi-squared 0,1, Odds ratio 1.0, c.i.95%, p n.s.. Taking in account only women with cardiomyopathy non-adherent hypertensive were 194 (5.2%) on 3752, non-adherent with MetS were 40 (7.2%) on 550, Chi-squared 4.2, Odds ratio 1.4, c.i.95%, p&lt;0.04. Finally taking into consideration only women without cardiomyopathy non-adherent hypertensive were 103 (4.9%) on 2105, non-adherent with MetS were 33 (7.7%) on 426, Chi-squared 6, Odds ratio 1.6, c.i.95%, p&lt;0.01.

Discussion and Conclusion
In our study the rate of nonadherence is much lower, however, there is an increased rate of non-adherence in women with MetS, when compared with hypertensive, regardless of the presence of cardiomyopathy, that in both cases doesn't impact adherence. The analysis of the causes of non-adherence is beyond the scope of this study, we know that nonadherence is due to many factors, but we can suppose that it is more difficult to adhere to the complex therapeutic approach needed in MetS. Perhaps the first step to improving adherence is the awareness of the problem by physicians. Otherwise, we can affirm that there is no difference in adherence to hypertension therapy between patients on primary or secondary prevention when there is an efficient connection among prescriber cardiologists, general practitioners, and hypertensive patients.