Early adherence to antihypertensive drugs and long‐term cardiovascular mortality in the “real world”

Salazar, Martín R.

doi:10.1111/jch.14319

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…Low adherence to drug prescriptions among hypertensive patients can influence the risk of CVD ( Abegaz et al, 2017 ; Salazar, 2021 ). Previous studies on adherence have mostly focused on baseline or time-constant rates ( Li et al, 2021 ), which could introduce bias in assessments of the associations between drug therapies and their outcomes.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events—a real-world longitudinal inception cohort study

Li,

Bijlsma,

de Vos

et al. 2024

Front. Pharmacol.

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IntroductionAntihypertensive drugs are used preventatively to lower the risk of cardiovascular disease events. Comparative effectiveness studies on angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and thiazides have yielded inconsistent results and given little consideration to patient adherence. Using a longitudinal cohort and considering time-varying adherence and confounding factors, we aimed to estimate the real-world effectiveness of five major antihypertensive drug monotherapies in the primary prevention of cardiovascular events.MethodsEligible patients for a retrospective inception cohort study were selected using information obtained from the University of Groningen IADB.nl pharmacy prescription database. Cohort 1 comprised adherent patients with a follow-up time exceeding 1 year, and cohort 2 comprised all patients independent of adherence. The exposures were ACEIs, ARBs, BBs, CCBs, and thiazides. The primary outcome was the time to the first prescription for an acute cardiac drug therapy (CDT) measured using valid drug proxies to identify the first major cardiovascular event. A per-protocol analytical approach was adopted with inverse probability of treatment weighted (IPTW), time-varying Cox regression analysis to obtain the hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsIn cohort 1 (n = 22,441), 1,294 patients (5.8%) were prescribed an acute CDT with an average follow-up time of 4.2 ± 2.8 years. Following IPTW, the hazard measures of ARBs and thiazides were lower than those of BBs (HRs: 0.79 and 0.80, respectively; 95% CIs: 0.64–0.97 and 0.69–0.94, respectively). Among drug-treated diabetic patients, the hazard measures were even lower, with HR point estimates of 0.43 (CI: 0.19–0.98) for ARBs and 0.32 (CI: 0.13–0.82) for thiazides. In cohort 2 (n = 33,427) and sensitivity analysis, the comparative effectiveness results for thiazides and BBs were similar to those for cohort 1.ConclusionThe findings of this real-world analysis suggest that the incidence of CDT associated with long-term thiazide or ARB monotherapy is lower than the incidence of CDT with BBs, notably among high-risk patients. Incidences of CDT associated with ACEIs and CCBs were comparable relative to those associated with BBs.

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Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events—a real-world longitudinal inception cohort study

Li,

Bijlsma,

de Vos

et al. 2024

Front. Pharmacol.

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Research strategies in treatment of hypertension: value of retrospective real-life data

Corrao

Mancia

2022

European Heart Journal

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This review will discuss the limitations of data collected by RCTs in relation to their applicability to daily life clinical management. It will then argue that these limitations are only partially overcome by modifications of RCT design and conduction (e.g. ‘pragmatic trials’) while being substantially attenuated by real-life-derived research, which can fill many gaps left by trial-collected evidence and have thus an important complementary value. The focus will be on the real-life research approach based on the retrospective analysis of the now widely available healthcare utilization databases (formerly known as administrative databases), which will be discussed in detail for their multiple advantages as well as challenges. Emphasis will be given to the potential of these databases to provide low-cost information over long periods on many different healthcare issues, drug therapies in particular, from the general population to clinically important subgroups, including (i) prognostic aspects of treatments implemented at the medical practice level via hospitalization and fatality data and (ii) medical practice-related phenomena such as low treatment adherence and therapeutic inertia (unsatisfactorily evaluated by RCTs). It will also be mentioned that thanks to the current availability of these data in electronic format, results can be obtained quickly, helping timely decisions under emergencies. The potential shortcomings of this approach (confounding by indication, misclassification, and selection bias) will also be discussed along with their possible minimization by suitable analytic means. Finally, examples of the contributions of studies on hypertension and other cardiovascular risk factors will be offered based on retrospective healthcare utilization databases that have provided information on real-life cardiovascular treatments unavailable via RCTs.

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Early adherence to antihypertensive drugs and long‐term cardiovascular mortality in the “real world”

Cited by 2 publications

References 16 publications

Comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events—a real-world longitudinal inception cohort study

Comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events—a real-world longitudinal inception cohort study

Research strategies in treatment of hypertension: value of retrospective real-life data

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