Adherence With Antihypertensive Drug Therapy and the Risk of Heart Failure in Clinical Practice

Abstract

Abstract-Randomized clinical trials have shown that antihypertensive treatment reduces the risk of heart failure (HF).Limited evidence exists, however, on whether and to what extent this benefit is translated into real-life practice. A nested case-control study was carried out by including the cohort of 76 017 patients from Lombardy (Italy), aged 40 to 80 years, who were newly treated with antihypertensive drugs during 2005. Cases were the 622 patients who experienced hospitalization for HF from initial prescription until 2012. Up to 5 controls were randomly selected for each case. Logistic regression was used to model the HF risk associated with adherence to antihypertensive drugs, which was measured by the proportion of days covered by treatment (PDC). Data were adjusted for several covariates. Sensitivity analyses were performed to account for possible sources of systematic uncertainty. Compared with patients with very low adherence (PDC, ≤25%), low, intermediate, and high adherences were associated with progressively lower risk of HF, reduction in the high-adherence group (>75%) being 34% (95% confidence interval, 17%-48%). Similar effects were observed in younger (40-70 years) and older (71-80 years) patients and between patients treated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. There was no evidence that adherence with calciumchannel blockers reduced the HF risk. Antihypertensive treatment lowers the HF risk in real-life practice, but adherence to treatment is necessary for a substantial benefit to take place. This is the case with a variety of antihypertensive drugs. Corrao et al Antihypertensive Agents and Heart Failure 743these, those who received at least 1 antihypertensive drug prescription during 2005 were identified, and the first dispensation was defined as the index prescription. Antihypertensive drugs included diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and calcium-channel blockers (CCBs) initially dispensed as monotherapy. Patients with an initial prescription of ≥2 antihypertensive drugs were excluded to reduce the range of hypertension severity, given that compared with monotherapy, need of multiple drug treatment reflects an increased risk of cardiovascular events, including HF. 14 Exclusion was extended to other patient categories, such as patients who (1) received at least 1 antihypertensive drug prescription within the 5 years before the index prescription, to limit inclusion to newly treated individuals; (2) had been hospitalized for cardiovascular disease or used drugs for coronary heart disease or HF, within the 5 years before the index prescription to limit data collection to the setting of primary cardiovascular prevention; (3) were beneficiaries of the National Health Service from <5 years before the start of prescription; and (4) did not reach at least 1 year of followup. Patients who had previously received ≥1 prescriptions of digitalis were also excluded because the use of digi...

Hypertension and Frailty Syndrome in Old Age: Current Perspectives

“…23 It can also be suspected to interfere with treatment adherence. 69 Few studies are available on the association between the components of geriatric syndrome and adherence to treatment. Those papers that discuss associations between frailty and adherence are based on populations with diseases other than hypertension.…”

Combination Antihypertension Therapy: Triple Fixed Combination of Antihypertensive Drugs

“…И эта необходимость во многом вытекает из низкой приверженности больных к антигипер-тензивной терапии. В узком смысле при лечении АГ под приверженностью подразумевают коррект-ный прием назначенных АГП (не менее 80% долж-ного) [18,19]. Прием некорректной дозы АГП или их прием в некорректное время, пропуски в при-еме и/или отказ от лечения представляют собой различные формы нарушения приверженности [18].…”

“…Прием некорректной дозы АГП или их прием в некорректное время, пропуски в при-еме и/или отказ от лечения представляют собой различные формы нарушения приверженности [18]. Как правило, наиболее частым вариантом плохой комплаентности является прием недоста-точных доз лекарств и пропуски приема в течение 1-3 дней [18,19].…”

Visit-to-Visit Blood Pressure Variability

“…This is an important issue to address because adherence to treatment has often been shown to markedly improve cardiovascular protection already when it raises to intermediate levels (50% to 75% of the available drugs), with little further advantage when the level increases further. 7,12 The third limitation originates from the previous ones. Because of the limited accuracy and extent of the adherence to treatment measures, adjustment for adherence to rule out its contribution to the adverse prognostic role of visitto-visit BP variability has inevitably a limited value.…”