***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Although a majority of patients with hypertension require a multidrug therapy , this is rarely considered when measuring adherence from refill data . Moreover , investigating the association between refill non-adherence to antihypertensive therapy ( AHT ) and elevated blood pressure ( BP ) has been advocated . Objective Identify factors associated with non-adherence to AHT , considering the multidrug therapy , and investigate the association between non-adherence to AHT and elevated BP . Methods A retrospective cohort study including patients with hypertension , identified from a r and om sample of 5025 Swedish adults . Two measures of adherence were estimated by the proportion of days covered method ( PDC≥80 % ) : ( 1 )  Adherence to any antihypertensive medication  and , ( 2 )  adherence to the full AHT regimen . Multiple logistic regressions were performed to investigate the association between sociodemographic factors ( age , sex , education , income ) , clinical factors ( user profile , number of antihypertensive medications , healthcare use , cardiovascular comorbidities ) and non-adherence . Moreover , the association between non-adherence ( long-term and a month prior to BP measurement ) and elevated BP was investigated . Results Non-adherence to any antihypertensive medication was higher among persons < 65 years ( Odds Ratio , OR 2.75 [ 95 % CI , 1.18–6.43 ] ) and with the lowest income ( OR 2.05 [ 95 % CI , 1.01–4.16 ] ) . Non-adherence to the full AHT regimen was higher among new users ( OR 2.04 [ 95 % CI , 1.32–3.15 ] ) , persons using specialized healthcare ( OR 1.63 , [ 95 % CI , 1.14–2.32 ] ) , and having multiple antihypertensive medications ( OR 1.85 [ 95 % CI , 1.25–2.75 ] and OR 5.22 [ 95 % CI , 3.48–7.83 ] , for 2 and ≥3 antihypertensive medications , respectively ) . Non-adherence to any antihypertensive medication a month prior to healthcare visit was associated with elevated BP . Conclusion Sociodemographic factors were associated with non-adherence to any antihypertensive medication while clinical factors with non-adherence to the full AHT regimen . These differing findings support considering the use of multiple antihypertensive medications when measuring refill adherence . Monitoring patients ' refill adherence prior to healthcare visit may facilitate interpreting elevated BP Abstract Objective : Fixed-dose combination therapy reduces pill burden and may , therefore , improve medication adherence and health outcomes . This study compared adherence to and persistence with single- , double- , and triple-pill treatment regimens among hypertensive patients in a US clinical practice setting . Methods : Adults with hypertension treated with three anti-hypertensive medications were identified . Index date was the first occurrence of a single- , double- , or triple-pill regimen with olmesartan or valsartan plus amlodipine and hydrochlorothiazide from July 2010 to September 2011 . Patients were followed for 12 months to assess adherence ( proportion of days covered [ PDC ] ≥ 80 % ) and time to discontinuation ( medication gap ≥60 days ) of the index regimen . Multivariate regression models were used to compare adjusted outcomes . Results : The number of prescribed pills in the index regimen was monotonically related to adherence with 55.3 % , 40.4 % and 32.6 % of patients having PDC ≥80 % in the single- , double- and triple-pill cohorts , respectively . In adjusted analysis , patients in the double- ( odds ratio [ OR ] : 0.45 ; 95 % confidence interval [ CI ] : 0.42–0.48 ) and triple-pill ( OR : 0.26 ; 95 % CI : 0.22–0.30 ) cohorts were less likely to be adherent to their index regimens than those in the single-pill cohort . Double-pill ( hazard ratio [ HR ] : 1.89 ; 95 % CI : 1.74–2.06 ) and triple-pill patients ( HR : 2.49 ; 95 % CI : 2.14–2.88 ) were more likely to discontinue treatment than single-pill patients . Conclusions : Greater pill burden was directly and significantly associated with decreased adherence and persistence with antihypertensive therapies in real- practice setting s. Use of fixed-dose combinations that reduce pill burden could help patients to continue treatment and may result in improved clinical outcomes . Typical of observational studies , the potential for residual confounding of adherence estimates remains due to lack of r and omization of treatment groups There is increasing evidence that patient centered care , including communication skills , is an essential component to chronic illness care . Our aim was to evaluate patient centered primary care as a determinant of medication adherence . We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey ( PCAS ) which measures elements of patient centered primary care . We prospect ively collected each patient ’s antihypertensive medication adherence for 6 months . Patients were characterized as adherent if they had medication for > 80 % . 654 surveys were returned ( 50.7 % ) ; and 499 patients with complete data were analyzed .  Antihypertensive adherence increased as scores in patient centered care increased [ RR 3.18 ( 95 % CI 1.44 , 16.23 ) bootstrap 5000 re sample s ] for PCAS score of 4.5 ( highest quartile ) versus 1.5 ( lowest quartile ) . Future research is needed to determine if improving patient centered care , particularly communication skills , could lead to improvements in health related behaviors such as medication adherence and health outcomes The problem of medication adherence is pronounced in hypertensive black men . However , factors influencing their adherence are not well understood . This secondary analysis of the ongoing Counseling African Americans to Control Hypertension ( CAATCH ) r and omized clinical trial investigated the patient , provider , and health care system factors associated with medication adherence among hypertensive black men . Participants ( N=253 ) were aged 56.6±11.6 years , earned < $ 20,000 yearly ( 72.7 % ) , and almost one half were on Medicaid ( 44 % ) . Mean systolic blood pressure was 148.7±15.8 mm Hg and mean diastolic blood pressure was 92.7±9.8 mm Hg . Over one half of participants ( 54.9 % ) were nonadherent . In a hierarchical regression analysis , the patient factors that predicted medication adherence were age , self-efficacy , and depression . The final model accounted for 32.1 % of the variance ( F=7.80 , df 10 , 165 , P<.001 ) . In conclusion , age , self-efficacy , and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers . Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence . Depression can be screened for and treated . Self-efficacy is modifiable and its implication s for practice would be the development of interventions to increase self-efficacy in black men with hypertension ABSTRACT BACKGROUND Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management . Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs . OBJECTIVES 1 ) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension : proper medication use , diet , and exercise ; 2 ) To evaluate the extent to which an instrument design ed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure . DESIGN Cross-sectional analysis of r and omized trial data . PATIENTS Six hundred and thirty-six primary care patients with hypertension . MEASUREMENTS 1 ) Demographic , socioeconomic , psychosocial , and health belief-related factors ; 2 ) measures of self-reported adherence to recommended medication use , diet recommendations , and exercise recommendations  , all collected at baseline assessment ; 3 ) systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) . RESULTS We identified patient factors associated with measures of non-adherence to medications , diet , and exercise in hypertension . We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables ( medication , diet , and exercise composites ) , reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior . These composite variables identified subgroups with higher likelihood of medication non-adherence , difficulty following diet recommendations , and difficulty following exercise recommendations . Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP . CONCLUSIONS We identified factors associated with measures of non-adherence to recommended medication use , diet , and exercise in hypertension . We then developed an instrument that was associated with non-adherence to these self-management behaviors , as well as with blood pressure . With further study , this instrument has potential to improve identification of non-adherent patients with hypertension Objective To examine the relationship between perceived discrimination and medication adherence among black people with hypertension and the role of stress and depressive symptoms in this relationship . Perceived racial discrimination has been associated with poor health outcomes in blacks ; its relationship to medication adherence among hypertensive patients remains untested . Methods We measured perceived racial discrimination at baseline , stress and depressive symptoms at 6 months , and medication adherence at 12 months among patients enrolled in a 30-site cluster-r and omized controlled trial testing a patient and physician-targeted intervention to improve blood pressure . A mediational method with bootstrapping ( stratified by site ) confidence intervals was used to estimate the indirect association between perceived discrimination and medication adherence through stress and depression . Results Of 1056 patients from 30 sites enrolled in the trial , 463 had complete data on all four measures at 6 and 12 months and were included in the analyses . Adjusting for clustering , perceived discrimination was associated with poor medication adherence ( B = 0.138 , p = .011 ) at 12 months , and with stress ( B = 2.24 , p = .001 ) and depression ( B = 1.47 , p = .001 ) at 6 months . When stress and depression were included in the model , there was a 65 % reduction in the total association of perceived discrimination with medication adherence , and the relationship was no longer significant ( B = 0.049 , p = .35 ) . Conclusions Perceived discrimination is associated with poor medication adherence among hypertensive blacks , and stress and depressive symptoms may account for this relationship . Trial Registration clinical trials.gov Identifier : NCT00233220 STUDY OBJECTIVES To determine characteristics associated with drug adherence and blood pressure control among patients with hypertension , and to assess agreement between self-reported and refill adherences . DESIGN Cross-sectional analysis of baseline data from an ongoing r and omized controlled trial . SETTING Primary care center at an urban , county health system in Indianapolis , Indiana . PATIENTS Four hundred ninety-two participants with hypertension and taking at least one antihypertensive drug . MEASUREMENTS AND MAIN RESULTS Social and demographic factors , comorbidity , self-reported drug adherence , prescription refill adherence , and systolic and diastolic blood pressures were recorded at baseline . Participants were aged 57 + /- 11 ( mean + /- SD ) years , were predominantly women ( 73 % ) and African-American ( 68 % ) , and took 2.4 + /- 1.1 antihypertensive drugs . Agreement between self-reported and refill adherences was poor to fair ( kappa = 0.21 ) . On multiple logistic regression analysis , increased age ( p < or = 0.002 ) and being married ( p=0.03 ) were independent predictors of improved self-reported and refill adherence , whereas depressed patients had low self-reported adherence ( p=0.005 ) , and African-Americans had low refill adherence ( p<0.001 ) . Compared with nonadherent patients , adherent patients had lower systolic ( -5.4 mm Hg by self-report and -5.0 mm Hg by refill ) and diastolic ( -2.7 mm Hg by self-report and -3.0 mm Hg by refill ) blood pressures ( p < or = 0.02 ) . Increased age was the only other variable strongly associated with systolic and diastolic blood pressure control in both measures of drug adherence ( p < or = 0.001 ) . The association of depression , race , and sex with blood pressure control was model dependent . CONCLUSION Age , sex , race and depression are associated with antihypertensive drug adherence and blood pressure control . Self-reported and refill adherences appear to provide complementary information and are associated with reductions in systolic and diastolic blood pressure of similar magnitude Background : The extent to which common life transitions influence medication adherence among patients remains unknown . We examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes . Methods : Participants in the Finnish Public S 
    Output:
    
Higher co-payment , side effects and a poor patient – provider relationship were identified as factors with consistent evidence since consistent significant relationships were found for these factors whenever studied .