Poor Blood Pressure Control Puts Five Million at Risk

Some five million Medicare Part D enrollees age 65 and older are not taking their blood pressure medicine properly, increasing their risk of heart disease, stroke, kidney disease, and death, according to a new report released on September 13, 2016, by the CDC. Medicare Part D is a federal program that helps Medicare beneficiaries with the costs of prescription drugs and prescription drug insurance premiums.


Seven out of 10 U.S. adults ages 65 and older have high blood pressure (140/90mmHg or higher), but nearly half do not have their blood pressure under control. The report outlines the dangers of high blood pressure and the important role health care systems play in helping patients take blood pressure medicines as directed.


“A simple action can avoid potentially deadly consequences: take your blood pressure medicine as prescribed,” said CDC Director Tom Frieden, M.D., M.P.H. “Health care providers can make treatment easier to help people keep their blood pressure controlled.”


The report analyzes data from more than 18.5 million people enrolled in Medicare Advantage or Original Medicare with Medicare Part D prescription drug coverage during 2014. The CDC and the Centers for Medicare & Medicaid Services (CMS) researchers looked at disparities in beneficiary adherence rates based on factors including geography, race/ethnicity, gender, income status, and medication class.


The following are some of the findings in the report. About five million Medicare Part D enrollees ages 65 or older are not taking their blood pressure medicine as directed. This means they may skip doses or stop taking it altogether. The percentage of Medicare Part D enrollees not taking their blood pressure medicine is higher among certain racial/ethnic groups (American Indian/Alaska Native, Black, and Hispanic). This contributes to these groups’ higher risk of heart attack, stroke, kidney disease, and death. There are also geographic differences. Southern U.S. states, Puerto Rico, and the U.S. Virgin Islands have the highest overall rates of not taking blood-pressure medicines as directed. North Dakota, Wisconsin, and Minnesota have the highest rates of people who do take their medicine as directed.


Health care systems—including doctors, nurses, pharmacists, community health workers, practices, hospitals, and insurers—can play a key role in improving blood pressure control nationwide. Health care systems can simplify blood pressure treatment (e.g. prescribe 90-day refills and combination medicines and coordinate pill refills for the same date) and prescribe generic medicines, involve the entire healthcare team at several points of care to ensure patients are taking medicine as directed and to address patient concerns about side effects, encourage the use of home blood pressure monitors and easy-to-use tools (e.g. blood pressure logs and mobile apps) to track and share blood pressure readings, and address financial barriers, such as high co-pays and deductibles. The CDC encourages health care systems to ensure that people understand the importance of blood pressure control and how taking blood pressure medicine as directed along with a healthy diet and exercise lowers risk of heart disease, kidney disease, and stroke.


The reasons people don’t take their blood pressure medicine as directed vary. Nearly 25% of new prescriptions for blood pressure medicine are never filled. People with high blood pressure often don’t have symptoms so some may not treat a problem they don’t notice. People don’t know when to take which pills when they have multiple medicines. Medicines may have unwanted side effects. People forget to take their medicine or refill prescriptions on time. And finally, medicine costs may be too high for some people.


The federal government is also providing resources to all states and Washington, D.C., to prevent chronic disease, including heart disease and stroke; helping states track medication adherence; and encouraging prescription drug plans to improve medicine use through the Medicare Star Ratings program.


“While the Medicare prescription drug program has increased the affordability and accessibility of prescription drugs, more can be done to encourage Medicare beneficiaries to take their medications as directed,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare will continue to work with prescription drug plans to educate enrollees about the importance of taking their blood pressure medications as prescribed so that they can lower their risk for heart disease and stroke.”


See the CDC Announcement


See the CDC Report


See also Medical Law Perspectives, September 2016 Report: Stroke: Challenges, Risks, and Liability Issues


See also Medical Law Perspectives, February 2015 Report: Mending a Broken Heart: Malpractice Risks in Diagnosing and Treating Heart Disease