(085) Adherence to Hypertension Treatment Among the Older Individuals: Do Depression and Anxiety Influence Adherence Trajectories?

Background: Hypertension is a common medical condition, especially among older individuals. Optimal management with antihypertensive medications is crucial to prevent cardiovascular complications. However, it can be challenging to adhere to antihypertensive treatments, especially as it can be affected by common mental health disorders such as depression and anxiety.

Objectives: The primary objective of our study was to explore the association between common mental health disorders (depression and anxiety) and adherence to antihypertensive medications among persons aged 65 and older in Quebec, Canada. We aimed to understand how these mental health conditions influenced medication adherence trajectories.

Methods: This study is a secondary analysis of the Étude sur la Santé des Aînés (ESA)-Services cohort, combining health survey and medico-administrative data for patients aged ≥65 years recruited in primary care settings. We conducted a cohort study to assess adherence, particularly its implementation phase, following the initiation of a new antihypertensive treatment.
The exposures are defined as having symptoms of depression or anxiety based on the criteria of the fourth edition of the Diagnostic and statistical manual of mental (DSM IV) disorders collected in the ESA-Services interviews. Adherence trajectories were identified using Group-Based Trajectory Modeling (GBTM) applied to monthly Continuous Multiple-Interval Medication Availability (CMA) measures over one year after the response to the health survey.
The associations between mental health disorders and adherence trajectories were analyzed using multinomial logistic regression models , adjusting for potential confounders, providing estimates and 95% confidence intervals.

Results: Among the 558 patients initiating a new antihypertensive medication during the study period, two distinct adherence trajectories were observed: consistently high monthly adherence (82.3%) and declining monthly adherence (17.7%). Anxiety was positively associated with consistently high adherence (β=-0.99 [-1.89; -0.09]), while depression showed no significant association with adherence patterns (β=0.14 [-0.62; 0.90]).

Conclusions: Our results show a positive association between anxiety and antihypertensive medication adherence among older individuals, unlike depression, which is not significantly associated with adherence. Considering the study's limitations, these observations underscore the importance of integrating mental health considerations in primary care hypertension management for the elderly.