Association Between Traditional Chinese Medicine and Medication Adherence in Hypertensive Patients in Mainland China: A Real-World Population-Based Cohort Study

Abstract

Abstract Background: Hypertension and associated CVD are the major public health challenges in China. Medication adherence is the cornerstone for achieving hypertension control and reduce the risk of CVD and mortality. Considering that more and more people have turned on complementary and alternative medicine(CAM) , combined with pharmacotherapy for treating hypertension, including Traditional Chinese Medicine(TCM).However, the relationship between medication adherence and TCM usage remains unknown. This study aimed to assess the association between non-pharmacological therapies of TCM and adherence to anti-hypertensive medication in mainland China. Methods: Data was extracted from the electronic health records of a Chinese medical hospital. A retrospective cohort study was conducted on hypertension patients enrolled between January 2016 and April 2021. Propensity score matching (PSM) was employed, resulting in 1179 patients in the TCM user group and 257 patients in the no TCM user group. Medication possession ratios (MPR) were used to measure medication adherence in the presence or absence of TCM. Generalized estimating equations (GEE) were applied to identify factors associated with adherence, including TCM exposure, age and sex. Results: Medication compliance in the real world was generally low, at approximately 10%. The percentage of TCM exposure among differed significantly between the two groups throughout the follow-up period. The proportions of optimal adherence (MPR≥ 80) and continuous treatment rate showed no significant difference. GEE regression results indicated that TCM visits could improve medication adherence to anti-hypertensive drugs. Subgroup analysis revealed that TCM use had a positive impact on optimal adherence for male patients and patients aged 60 years and above (p<0.05). Conversely, there was no association between TCM use and MPR in female patients. Conclusions: Notably, medication compliance was higher among TCM users compared to no TCM users. TCM exposure appeared to have a positive effect on medication adherence in hypertensive patients, suggesting its potential as a complementary approach to conventional Western drug therapy. This study provides important insights for integrating Chinese and Western medicine to enhance adherence to anti-hypertensive medications.