{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:39:39Z","timestamp":1783211979432,"version":"3.54.6"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Blood pressure (BP) control remains suboptimal in the United States despite available low\u2010cost antihypertensive medications. Even small out\u2010of\u2010pocket medication costs may contribute to adherence. We determined whether $0 versus &gt;$0 out\u2010of\u2010pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2\u2010stage residual inclusion leveraged differences in medication copay policy at a 50% service\u2010connected disability threshold (\u226550% service\u2010connected disability: $0 out\u2010of\u2010pocket cost versus &lt;50%: $8 monthly cost). Outcomes included 1\u2010year medication nonadherence (proportion of days covered &lt;80%), 1\u2010year medication discontinuation (no medication in the final 90\u2009days of the study year), 1\u2010year BP control (systolic BP\/diastolic BP &lt;140\/90\u2009mm\u2009Hg and &lt;130\/80\u2009mm\u2009Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 417\u2009705 veterans (mean\u00b1SD age, 56 [13] years; 92% male; 61% non\u2010Hispanic White), 296\u2009432 (71%) had $0 out\u2010of\u2010pocket costs. Accounting for changes in eligibility for $0 copays at the 50% service\u2010related disability threshold, $0 out\u2010of\u2010pocket costs were associated with lower odds of nonadherence (odds ratio [OR], 0.87 [95% CI, 0.81\u20130.94]) and medication discontinuation (OR, 0.77 [95% CI, 0.71\u20130.84]). One\u2010year BP control &lt;140\/90\u2009mm\u2009Hg or &lt;130\/80\u2009mm\u2009Hg and cardiovascular disease events events were similar between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among veterans with newly diagnosed hypertension, modest out\u2010of\u2010pocket medication costs were associated with lower adherence and discontinuation. These findings can inform ongoing discussions regarding policy levers for improving hypertension outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047792","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:46:52Z","timestamp":1775728012000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Out\u2010of\u2010Pocket Costs and Antihypertensive Medication Use Among Veterans: A Natural Experiment"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5578-782X","authenticated-orcid":false,"given":"Alexander R.","family":"Zheutlin","sequence":"first","affiliation":[{"name":"Northwestern University","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5936-8340","authenticated-orcid":false,"given":"Alexander","family":"Chaitoff","sequence":"additional","affiliation":[{"name":"University of Michigan","place":["Ann Arbor, USA"]},{"name":"Veterans Affairs Ann Arbor Healthcare System","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3450-6718","authenticated-orcid":false,"given":"Daniel","family":"Addo","sequence":"additional","affiliation":[{"name":"Spencer Fox\u2010Eccles School of Medicine, University of Utah","place":["Salt Lake City, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9621-9060","authenticated-orcid":false,"given":"Joshua A.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah","place":["Salt Lake City, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-4607","authenticated-orcid":false,"given":"Catherine G.","family":"Derington","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine","place":["Aurora, USA"]},{"name":"Adult & Child Center for Outcomes Research & Dissemination, University of Colorado Anschutz Medical Campus","place":["Aurora, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3075-4597","authenticated-orcid":false,"given":"Eric L.","family":"Stulberg","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Glynn","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, University of Illinois Chicago","place":["Chicago, USA"]},{"name":"Jesse Brown Veterans Affairs Medical Center","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8912-6600","authenticated-orcid":false,"given":"Bernardo","family":"Modenesi","sequence":"additional","affiliation":[{"name":"Spencer Fox\u2010Eccles School of Medicine, University of Utah","place":["Salt Lake City, USA"]},{"name":"University of Utah","place":["Salt Lake City, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4649-079X","authenticated-orcid":false,"given":"Jordana B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania","place":["Philadelphia, USA"]},{"name":"Perelman School of Medicine, University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2259-5039","authenticated-orcid":false,"given":"Adam P.","family":"Bress","sequence":"additional","affiliation":[{"name":"Spencer Fox\u2010Eccles School of Medicine, University of Utah","place":["Salt Lake City, USA"]},{"name":"George E. 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