Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension.
Jennifer B Levin, David J Moore, Farren Briggs, Mahboob Rahman, Jessica Montoya, Colin Depp, Douglas Einstadter, Kurt C Stange, Celeste Weise, Taylor Maniglia, Richard Barigye, Gracie Howard Griggs, Clara Adeniyi, Joy Yala, Martha Sajatovic
Author Information
Jennifer B Levin: Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. ORCID
David J Moore: Department of Psychiatry, University of California San Diego, San Diego CA, USA.
Farren Briggs: Department of Public Health Sciences, Division of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Mahboob Rahman: Department of Internal Medicine, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
Jessica Montoya: Department of Psychiatry, University of California San Diego, San Diego CA, USA.
Colin Depp: Department of Psychiatry, University of California San Diego, San Diego CA, USA.
Douglas Einstadter: Departments of Medicine and Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Kurt C Stange: Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Celeste Weise: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Taylor Maniglia: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Richard Barigye: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Gracie Howard Griggs: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Clara Adeniyi: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Joy Yala: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Martha Sajatovic: Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
OBJECTIVE: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This study examined the association between adherence to antihypertensive, adherence to BD medications, and clinical symptoms in patients with BD and comorbid hypertension (HTN). Participants were involved in an ongoing clinical trial. METHOD: Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pill bottle that captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over one week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. RESULTS: A total of 83 participants with BD and HTN were included. Adherence to BD medications and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than participants self-reported for antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline, whereas antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. CONCLUSIONS: Adherence levels fluctuated over time and differed based on measurement method in participants with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to a change in self-reported adherence. BD symptom severity may interfere with medication adherence in patients with BD and should be considered in treatment planning.
