Abstract 206: Incorporation Of Clinical Parameters To Morisky Medication Adherence Scale Assessment Improves Its Ability To Predict Non-adherence In Patients With Resistant Hypertension
Background: Morisky Medication Adherence scale (MMAS), a self-report questionnaire for screening non-adherence, has been validated in patients with uncomplicated hypertension. However, its accuracy in predicting non-adherence in patients with resistant hypertension (RH) is not known.
Methods: A retrospective chart review was performed in 91 patients with RH referred to hypertension clinic from 2009 to 2013 that filled out a MMAS survey during the initial clinic visit. Non-adherence was confirmed by presence of undetected serum levels of at least 1 prescribed antihypertensive drug by therapeutic drug monitoring (TDM).
Results: By MMAS, 27% (25/91) patients had low adherence, 30% (27/91) medium adherence, and 43% (39/91) high adherence with no significant difference in mean BP among these groups. MMAS was limited in its ability to predict non-adherence when validated against TDM (sensitivity=40%; specificity = 33%) and was not an independent predictor of non-adherence. However, clinical characteristics such as Heart rate (HR), Heart Failure (HF) and systolic BP (SBP) were independent predictors of non-adherence after multivariable adjusted logistic regression analysis. Area under the curve (AUC) resulting from receiver operator curve (ROC) analyses was greater for clinical predictors (SBP+HF+HR) than the MMAS score alone (0.89 vs. 0.65). When SBP, HF, and HR were added to model with MMAS score, the AUC increased significantly (see Fig; MMAS= 0.65; MMAS + SBP +HF + HR= 0.91).
Conclusion: Ability of MMAS to predict non-adherence in patients with RH can be significantly improved by incorporating clinical parameters readily available for physicians in clinical practice.
Author Disclosures: A. Pandey: None. F. Raza: None. A. Velasco: None. S. Brinker: None. C. Ayers: None. D. Arbique: None. A. Price: None. W. Vongpatanasin: None.
- © 2014 by American Heart Association, Inc.