Some US Regions and Ethnicities At Greater Risk of Non-Adherence to Blood Pressure Medications Interview with:

Matthew Ritchey, DPT, PT, OCS, MPH Epidemiologist Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion

Dr. Matthew Ritchey

Matthew Ritchey, DPT, PT, OCS, MPH
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion What is the background for this study?

Response: High blood pressure is a leading cause of heart disease, stroke, kidney disease and death. Unfortunately, almost one in three U.S. adults (around 75 million) has high blood pressure, and nearly half of that group (about 34 million) doesn’t have it under control.

As part of CDC’s ongoing efforts to monitor trends and risk factors contributing to cardiovascular disease, we collaborated with colleagues at the Centers for Medicare and Medicaid Services to look at blood pressure medicine nonadherence among Medicare Part D enrollees ages 65 and over. Being nonadherent means that patients skip doses of their medicine or stop taking it altogether. What are the main findings?

Response: We found that more than a quarter of Medicare Part D enrollees with prescriptions for blood pressure medicine—or about five million people—are not taking it as directed. We also found that blood pressure medication nonadherence is a problem for all race-ethnicities and geographies. However, we identified certain groups who had particularly high rates. For example, compared to one in four Medicare Part D enrollees who were Asian or non-Hispanic white not taking their blood pressure medication as directed, one in three enrollees who were black, Hispanic or American Indian/Alaska Natives were not doing so. This puts them at higher risk of heart attack, stroke, kidney disease and death. There were also geographic differences. The southern U.S. states, Puerto Rico and the U.S. Virgin Islands have the highest overall rates of people on Medicare Part D that aren’t taking their blood pressure medicine as directed, while North Dakota, Wisconsin and Minnesota have the lowest rates.

This research is beneficial because it helps reveal patterns of and disparities in nonadherence. By revealing how many patients are not following doctor’s orders—and if those patients are clustered in specific geographic pockets—we can better target public health efforts in high risk areas and among high risk populations. What should readers take away from your report?

Response: Blood pressure medicine can play a significant role in improving and protecting a patient’s health, but only if taken as prescribed. Our study reveals too many American adults are not taking their blood pressure medicine as prescribed—and this is a big problem with costly and potentially deadly consequences.

Health care systems can play a key role in improving adherence and blood pressure control nationwide. For example, doctors, nurses and other healthcare professionals can check blood pressure and prescribe simple regiments, such as 90-day fills and combination medicines. Pharmacists can enroll patients in reminder programs to help them renew prescriptions on time, while community health workers can connect patients with local resources to help improve and manage blood pressure.

The medicine use process can be complex, but there are opportunities along the various points of the care continuum. If healthcare systems work as a team across this continuum, they can help to encourage healthy lifestyle changes and remove some of the barriers that patients might face when taking medicine What recommendations do you have for future research as a result of this study?

Response: This study helps to answer the “What” and “Who” regarding blood pressure medication nonadherence: “What is the extent of the problem?” and “Who is highest risk?” Previous research has looked at the “Why” and “How”: “Why are certain groups and regions having greater difficulty remaining adherent to their blood pressure medication regimens?” and “How do we best support patients in taking their medicine as prescribed?”

We now need additional evaluation of scalable, comprehensive blood pressure control interventions that address nonadherence and, if deemed effective, can be replicated by health care systems across the country. Is there anything else you would like to add?

Response: Heart disease, stroke and other cardiovascular diseases kill more than 800,000 Americans each year, accounting for one in every three deaths. Previous CDC research has shown that at least 200,000 cardiovascular deaths could be prevented each year through lifestyle changes or managing medical conditions like high blood pressure. Controlling blood pressure is one of the most important steps people can take to improve heart and brain health and enjoy longer, healthier lives. Thank you for your contribution to the community.


Ritchey M, Chang A, Powers C, et al. Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:967-976. DOI:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on September 19, 2016 by Marie Benz MD FAAD