Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients

Mazzaglia, Giampiero; Ambrosioni, Ettore; Alacqua, Marianna; Filippi, Alessandro; Sessa, Emiliano; Immordino, Vincenzo; Borghi, Claudio; Brignoli, Ovidio; Caputi, Achille P.; Cricelli, Claudio; Mantovani, LG

doi:10.1161/circulationaha.108.830299

Cited by 558 publications

(473 citation statements)

References 44 publications

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“…In our study, around 60% of beneficiaries had PDC ≥80%, which is consistent with previous studies 9, 19. However, in this analysis, we observed a greater risk reduction associated with antihypertensive adherence than in other studies 13, 19, 42. In addition, our dose‐response analysis of PDC and risk for CVD events suggested a threshold effect of PDC at around 80%.…”

Section: Discussionsupporting

confidence: 92%

“…In addition, our dose‐response analysis of PDC and risk for CVD events suggested a threshold effect of PDC at around 80%. Some studies also reported insignificant risk reduction comparing the intermediate adherence (40–79%) to low adherence (<40%),13, 19, 38 but others reported more‐gradual risk reduction associated with increased adherence 39, 40, 41. The reasons for the discrepancies in risk reduction are not clear.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the benefit of antihypertensive therapies, many studies suggested suboptimal adherence to these medications, particularly among older adults with multiple chronic conditions 4, 5, 6, 7, 8, 9, 10, 11. Nonadherence to antihypertensives is associated with increased risk for CVD, hospitalization, and healthcare costs 5, 12, 13, 14, 15, 16, 17. Many observational studies examined the relationship between antihypertensive adherence and CVD outcomes in the general hypertension population 5, 13, 17.…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

102

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BackgroundAntihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (CVD); few studies have examined this association among older adults.Methods and ResultsWe assessed this association among Medicare fee‐for‐service beneficiaries aged 66 to 79 years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008–2009 (n=155 597). We calculated proportion of days covered (PDC) during follow‐up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite CVD outcomes, including first incident of fatal/nonfatal acute myocardial infarction, ischemic heart disease, stroke/transient ischemic attack, and heart failure. During follow‐up (median 5.8 years and 798 621 person‐years), we documented 47 198 CVD events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had PDC ≥80%, 40% to 79%, and <40%. Crude incidence of CVD events were 40.1 (95% CI, 40.0–40.1), 93.9 (93.8–93.9), and 98.1 (98.1–98.2) per 1000 person‐years for PDC ≥80%, 40% to 79%, and <40%, respectively. Adjusted hazard ratios for CVD events were 1.0 (<40% as reference), 1.0 (0.97–1.03) for 40% to 79%, and 0.44 (0.42–0.45) for ≥80% (P<0.001). Dose‐response analysis suggested a nonlinear relationship between PDC and risk for CVD events with a protective effect of ≥80%. The pattern of associations between PDC and ischemic heart disease, stroke/transient ischemic attack, and heart failure were largely consistent as for CVD events and across different groups.ConclusionsAntihypertensive adherence was associated with a significantly lower risk of CVD events among older adults. There appeared to be a threshold effect in reducing CVD events at around PDC 80%, above which the risk for CVD reduced substantially.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

102

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“…It is well accepted that nonadherence to pharmacological therapy is the pivotal challenge of successful blood pressure (BP) control because antihypertensive therapy implies, in most cases, a lifelong treatment 1, 2, 3, 4. Several outcome research studies found that nonadherence to antihypertensive agents significantly increased cardiac and cerebrovascular risk 5, 6, 7. Furthermore, the choice of prescribed drug class affects adherence rates of antihypertensive therapies 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Antihypertensive Medication in Treatment‐Resistant Hypertension Undergoing Renal Denervation

Schmieder

Ott

Schmid

et al. 2016

JAHA

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BackgroundAdherence to medication has been repeatedly proposed to represent a major cause of treatment‐resistant hypertension (TRH); however, treatment decisions such as treating TRH with renal denervation depend on accurate judgment of adherence. We carefully analyzed adherence rates to medication before and after renal denervation and its effect on blood pressure (BP) control.Methods and ResultsEighty patients with TRH were included in 2 prospective observational studies that assessed the difference of potential antihypertensive and nephroprotective effects of renal denervation. To compare prescribed with actual medication intake (representing a measure of adherence), we analyzed urine samples collected at baseline and at 6 months after renal denervation for antihypertensive compounds or metabolites (by liquid chromatography–mass spectrometry). In addition to office BP, 24‐hour ambulatory BP and central hemodynamics (central systolic pressure, central pulse pressure) were assessed. Informed consent for analyses of urine metabolites was obtained from 79 of 80 patients. Actual intake of all antihypertensive drugs was detected at baseline and at 6 months after renal denervation in 44 (56%) and 52 (66%) patients, respectively; 1 drug was missing in 22 (28%) and 17 (22%) patients, respectively, and ≥2 drugs were missing in 13 (16%) and 10 (13%) patients, respectively. At baseline, 24‐hour ambulatory BP (P=0.049) and central systolic BP (P=0.012) were higher in nonadherent patients. Adherence did not significantly change overall (McNemar‐Bowker test, P=0.362). An increase in adherence was observed in 21 patients, and a decrease was observed in 11 patients. The decrease in 24‐hour ambulatory BP was not different in those with stable adherence 6 months after renal denervation (n=41, −7±13 mm Hg) compared with those with increased adherence (n=21, −10±13 mm Hg) and decreased adherence (n=11, −7±14 mm Hg) (P>0.20). Our study is limited by the relatively small sample size and potentially by the specific health environment of our university center (Northern Bavaria, Germany).ConclusionsNonadherence to medication among patients with TRH was relatively low: ≈1 of 6 patients with TRH did not take ≥2 of the prescribed drugs. Adherence pattern did not change significantly after renal denervation and had no impact on the overall observed BP changes, supporting the concept that renal denervation is an effective treatment in patients with TRH.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00888433, NCT01442883 and NCT01687725.

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“…The authors concluded that the main lifestyle modification associated with newly diagnosed hypertensive patients was smoking cessation, with an 18.6 % relative risk reduction (Neutel et al 2008). Mazzaglia et al (2009) assessed the proportion of days covered by medication in 18,806 patients (mean age, 62 years; 41.6 % were males and 27.5 % had at least one cardiovascular risk factor) at baseline, which was 6 months after newly diagnosed hypertension. At baseline, 51.4 % showed low adherence, 40.5 % intermediate adherence, and 8.1 % high adherence.…”

Section: Thrombophilia/factor V Leidenmentioning

confidence: 99%

Patient compliance based on genetic medicine: a literature review

Schneider

Schmidtke

2013

J Community Genet

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For this literature review, medical literature data bases were searched for studies on patient compliance after genetic risk assessment. The review focused on conditions where secondary or tertiary preventive options exist, namely cancer syndromes (BRCA-related cancer, HNPCC/colon cancer), hemochromatosis, thrombophilia, smoking cessation, and obesity. As a counterpart, patient compliance was assessed regarding medication adherence and medical advice in some of the most epidemiologically important conditions (including high blood pressure, metabolic syndrome, and coronary heart disease) after receiving medical advice based on nongenetic risk information or a combination of genetic and nongenetic risk information. In the majority of studies based on genetic risk assessments, patients were confronted with predictive rather than diagnostic genetic profiles. Most of the studies started from a knowledge base around 10 years ago when DNA testing was at an early stage, limited in scope and specificity, and costly. The major result is that overall compliance of patients after receiving a high-risk estimate from genetic testing for a given condition is high. However, significant behavior change does not take place just because the analyte is "genetic." Many more factors play a role in the complex process of behavioral tuning. Without adequate counseling and guidance, patients may interpret risk estimates of predictive genetic testing with an increase in fear and anxiety.

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Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients

Abstract: Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events.

Cited by 558 publications

References 44 publications

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Adherence to Antihypertensive Medication in Treatment‐Resistant Hypertension Undergoing Renal Denervation

Patient compliance based on genetic medicine: a literature review

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