Cardiovascular Health Indicator
Measure: Blood Pressure Medication Adherence

Analysis

As shown in Table 1 and Chart 1 below, adherence to ACE Inhibitors and ARBs has improved by 4.5 percentage points since 2010, from 73.8% to 78.3%. Adherence to diuretics has consistently lagged ACE Inhibitors and ARBs, but has also improved slightly from 2010 to 2015, rising from 70.2% to 72.7%.

Table 1: Blood Pressure Medication Adherence for Minnesota Adults, 2010-2015

Chart 1: Blood Pressure Medication Adherence for Minnesota Adults, 2010-2015

Table 2 shows the percentage of adults who are adherent to their blood pressure medication improves with age. For patients 65 years of age and older, approximately 8 out of 10 are taking their blood pressure medications according to their doctor’s orders; this drops to only slightly more than half of adults 18 to 44 years of age.

Table 2: Blood Pressure Medication Adherence by Age Group, 2015

Table 3 shows disparities in blood pressure medication adherence by type of insurance. Medicaid beneficiaries have the lowest rate of adherence to blood pressure medication and Medicare patients have the highest (25.9 percentage points lower for ACE Inhibitors or ARBs and 24.5 percentage points lower for diuretics). This is consistent with the pattern by age, as patients on Medicare are much more likely to be 65 years or older.

Table 3: Blood Pressure Medication Adherence by Type of Insurance, 2015

Other Resources

• Medicare Part C and D Performance Data
  This page from the Centers for Medicare & Medicaid Services (CMS) allows users to download spreadsheets of performance data on medication adherence (including blood pressure medications) for Medicare Part D Prescription Drug contracts.


• Interactive Atlas of Heart Disease & Stroke
  Online mapping tool from CDC with health indicators (including mortality and hospitalizations), risk factors, social and economic data, health care delivery, insurance, and health care costs data for states and counties. Some census tract data is also available.

Data Source

The data are analyses conducted by the Minnesota Department of Health based on pharmacy, medical, and enrollment data from the Minnesota All Payer Claims Database (MN APCD). The MN APCD is a state repository of health care claims data that is derived from medical providers’ billing records sent to insurance companies, plan administrators and public payers. It contains claims for about 89 percent of Minnesotans with insurance coverage.

Measure Definition

This measure uses a calculation of proportion of days covered (PDC). The PDC calculation is based on the fill dates and days supply for each fill of a prescription. The denominator for the PDC (at the patient-level) is the number of days between the first fill of the medication during the measurement period and the end of the measurement period. The patient-level numerator for the PDC is the number of days covered by the prescription fills during the denominator period. A patient must have been covered for at least 80% of the days to meet the measure. The adherence measure is the percent of adults taking a blood pressure medication who have met the 80% days covered threshold. This measure looks at two types of blood pressure medications: renin angiotensin system antagonists (RASAs), which includes both Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs), and diuretics.