PTSD and Medication Non-Adherence

Ian Kronish, MD, Interview with:
Ian Kronish, MD, MPH
Assistant Professor of Medicine
Center for Behavioral Cardiovascular Health
Division of General Medicine
Columbia University Medical Center What are the main findings of the study?

Dr. Kronish: Among primary care patients with persistently uncontrolled blood pressure despite medication treatment, we found that medication non-adherence was more than twice as common in patients with PTSD (68%) as compared to patients without PTSD (26%). The association between PTSD and medication non-adherence remained present after adjustment for key covariates including regimen complexity and depression. Recent research shows that PTSD not only contributes to psychological distress, but is also associated with increased risk for incident and recurrent cardiovascular disease. The data from our study suggest that medication non-adherence may be an important mechanism by which PTSD increases risk for cardiovascular disease. 

Were any of the findings unexpected?

Dr. Kronish: While the overall prevalence of non-adherence to blood pressure medications in our sample (41% were non-adherent defined as taking <80% of their antihypertensive doses as prescribed) was typical of other studies, we were surprised that non-adherence to blood pressure medications was so prevalent among patients with PTSD. We were also surprised that the association between PTSD and non-adherence did not appear to be weakened by including depression in the multivariable model. What should clinicians and patients take away from your report?

Dr. Kronish: PTSD is common in medical settings, and unfortunately, often goes unrecognized. Clinicians who are aware of significant PTSD symptoms in their patients should carefully assess medication adherence, particularly if their patients are not reaching goals for risk factor control. What recommendations do you have for future research as a result of this study?

Dr. Kronish: This study was conducted in a single primary care clinic that serves an inner-city, economically vulnerable community. Future research should confirm the association between PTSD and medication non-adherence in other study populations. Future research should also seek to understand which aspects of PTSD lead to non-adherence. We hypothesize that patients with PTSD may be avoidant of stimuli that remind them of their own mortality and this avoidance may lead them to miss important life-preserving cardiovascular medications such as antihypertensives. Future studies should also examine whether non-adherence is an important mediator of the association between PTSD and increased cardiovascular risk.

Finally, future research should consider the risks and benefits of screening for PTSD in primary care; if increased awareness of PTSD can help with the identification of patients who will benefit from adherence monitoring and improvement interventions, then there may be an increased benefit to PTSD screening.


Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension

 Kronish IM, Lin JJ, Cohen BE, Voils CI, Edmondson D. Posttraumatic Stress Disorder and Medication Nonadherence in Patients With Uncontrolled Hypertension. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.12881.

Last Updated on December 3, 2013 by Marie Benz MD FAAD