Better compliance to antihypertensive medications reduces cardiovascular risk

Corrao, Giovanni; Parodi, A. Ferretto; Nicotra, Federica; Zambon, Antonella; Merlino, Luca; Cesana, Giancarlo; Mancia, Giuseppe

doi:10.1097/hjh.0b013e328342ca97

Cited by 303 publications

(251 citation statements)

References 51 publications

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“…Pharmacological methods include antihypertensive medications daily [9][10][11]. This is increasingly coupled with measures to enhance adherence to the medicines prescribed given current concerns, coupled with other measures to reduce morbidity and mortality [1,12,13]. Non-pharmacological methods include restricting sodium intake to 80-100 mmol/day, weight loss, exercise and dietary changes [8,14] as well as stress reduction through relaxation methods such as yoga [15,16].…”

Section: Introductionmentioning

confidence: 99%

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

et al. 2017

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This version is available at https://strathprints.strath.ac.uk/59545/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. AbstractIntroduction: Hypertension is a leading global health problem requiring lifelong treatment. However, adherence to antihypertensive medicines is a problem, higher among developing countries. Consequently, there is a need to determine current adherence rates and their associations among developing countries to plan future initiatives. Methods: Cross-sectional study among adult outpatients with essential hypertension in Tanzania. Pre-designed questionnaires were used to gather information on adherence rates and patient-related beliefs. The main outcome measure was adherence. Results: 180 participants were included, with females making up 65%. High adherence rates in 54% of patients. Patients' belief about their medication and its necessity were higher in the high adherent group and concerns about their medicines and their necessity higher in the low adherent group. Conclusion: Adherence rates were low compared to a suggested level ≥ 80 %.

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Section: Introductionmentioning

confidence: 99%

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

et al. 2017

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“…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%

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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“…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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Better compliance to antihypertensive medications reduces cardiovascular risk

Abstract: In the real life setting, fulfillment compliance with antihypertensive medications is effective in the primary prevention of cardiovascular outcomes.

Cited by 303 publications

References 51 publications

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

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

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