PTSD patients most likely to skip hypertension medications

Among primary care patients with uncontrolled hypertension, medication nonadherence was more than twice as common in patients with post-traumatic stress disorder (PTSD) (68%) as compared to patients without PTSD (26%), according to a study reported online in JAMA Internal Medicine.

The association between PTSD and medication non-adherence remained present even after adjustment for key covariates including regimen complexity and depression, according to study author Ian Kronish, MD, MPH, of Columbia University in New York City, and colleagues.

Dr Kronish and his colleagues enrolled a sample of primary care patients who had persistently uncontrolled hypertension from a primary care clinic in New York City. They assessed patients for PTSD using the 4-item PTSD-Primary Care screening questionnaire. They then asked patients to take their blood pressure medications from an electronic pillbox that records the date and time when they open the pillbox compartments.

“We used this information to calculate the patients’ adherence to medications. We then compared the prevalence of nonadherence to medications in patients who did and did not screen positive for PTSD,” Dr Kronish told Formulary.

This study was part of a larger study that seeks to understand the psychological factors that underlie nonadherence to antihypertensive medications, Dr Kronish explained.

“We became particularly interested in assessing whether PTSD was a risk factor for nonadherence as there is increasing evidence that PTSD is associated with increased risk for cardiovascular disease and we wanted to know if poor medication adherence could help explain this association,” he said.

This study highlights the association between psychological disorders and nonadherence to medical treatment. “Enhanced screening and treatment for psychological disorders such as PTSD may help identify patients in need of adherence interventions and may have a beneficial effect on adherence to medical treatment and outcomes for medical conditions that depend on good adherence. In addition, managed care and hospital-decision makers should consider encouraging enhanced assessment of nonadherence among patients who are known to have PTSD,” Dr Kronish said.

Recent research shows that PTSD not only contributes to psychological distress, but is also associated with increased risk for incident and recurrent cardiovascular disease, according to the study authors.

“The data from our study suggest that medication nonadherence may be an important mechanism by which PTSD increases risk for cardiovascular disease,” Dr Kronish said. “Clinicians should carefully assess patients with PTSD for medication adherence problems. Future research should seek to confirm these findings in other settings and should seek to understand why patients with PTSD are at increased risk for medication nonadherence.”