Disparities/Minority Health

Asian Pacific American ethnic groups vary in their adherence to antihypertensive drug therapy

Adherence to antihypertensive medications can markedly reduce the incidence of stroke, heart attack, and congestive heart failure. Certain Asian Pacific American groups, such as the Japanese, have a high rate of hypertension (nearly three-fourths of men aged 71 to 93). A new study found that Japanese people living in Hawaii are more likely than whites to adhere to their antihypertensive medication, yet the disparities in adherence among Asian Pacific Americans indicates that subgroups need to be studied separately.

Researchers studied compliance with antihypertensive medication using a prescription database for 28,395 members with hypertension, all of whom were enrolled in a large health plan in Hawaii from 1999 to 2003. Even after adjusting for physician and patient characteristics, the Japanese in Hawaii were 21 percent more likely than whites to adhere to antihypertensive therapy (possessing the medication 80 percent or more of the time). Yet Filipinos, Koreans, and Hawaiians were 31 percent, 21 percent, and 16 percent, respectively, less likely than whites to adhere to the medication regimen prescribed for their high blood pressure. These results did not differ by type of medication. However, 70 percent of patients in the study were only on one antihypertensive agent, when combination therapy (usually a diuretic and another antihypertensive agent) is typically recommended.

Several other patient factors were associated with lower adherence, including younger age, history of heart disease, and higher number of coexisting illnesses. Physician characteristics were also strongly associated with adherence. Patients of female physicians, Chinese or Filipino physicians, and cardiologists or other specialists were less likely to adhere to treatment. Even Filipino patients seeing Filipino physicians and Chinese patients seeing Chinese physicians were less likely to consistently take their medication.

This suggests that provider-patient ethnic congruency alone will not solve the medication adherence problem. The study was supported by the Agency for Healthcare Research and Quality (HS11627).

More details are in "Antihypertensive adherence and drug class among Asian Pacific Americans," by Deborah A. Taira, Sc.D., Rebecca P. Gelber, James Davis, and others, in the June 2007 Ethnicity and Health 12(3), pp. 265-281.

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