Retirement a sticking point for antihypertensive adherence

By Eleanor McDermid, Senior medwireNews Reporter

Patients’ adherence to their antihypertensive medication may decline when they retire from work, a study shows.

Mika Kivimäki (University College London, UK) and colleagues describe this effect of retirement as “a timely issue given that the proportion of people aged 65 years or older is growing rapidly.”

As reported in the Canadian Medical Association Journal, the team looked at the medication adherence of 3468 patients with hypertension, identified from the Finnish Public Sector Study.

During the 3 years prior to retirement, the rate of nonadherence (defined as not filling sufficient prescriptions to cover at least 40% of days) to antihypertensive treatment was 5.6% among men and 6.1% among women. But during the 4 years after retirement, the rates rose significantly to 7.2% and 7.5%, respectively. Adherence to antidiabetic medication (among 412 patients) also declined, but was significant only among men.

The researchers note that retirement has been shown to result in a lasting improvement in perceived health. “Given that hypertension and type 2 diabetes are often asymptomatic, a perception of reduced symptoms of ill health after retirement may result in a sense of false security encouraging reduced medication use,” they say.

Kivimäki et al suggest that factors such as a change in routine and the transition from occupational to nonoccupational healthcare may also play a part. Change in earnings is unlikely to contribute, they add, given that the effect was seen regardless of socioeconomic status and that medication costs in Finland are largely met by national insurance.

The decline in medication adherence occurred regardless of patients’ age at retirement, the type of work they did (manual or nonmanual), the size of their residence, their reasons for retirement (statutory or health), and whether they had comorbid depression or cardiovascular disease.

Adherence was reduced during every postretirement year, suggesting that it was not a temporary effect caused by the initial adjustment to being retired. The effect also persisted when the team assessed difference thresholds for nonadherence (eg, <80% of days covered).

The researchers say that “randomized controlled trials are needed to determine whether interventions to tackle this issue would improve clinical outcomes of treatment.”

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