Antihypertensive nonadherence poses vascular risk
medwireNews: Patients with hypertension risk serious cardiovascular outcomes if they are not adherent to their antihypertensive medication, say researchers.
The effect of nonadherence was driven mainly by an increased risk for all-cause death and hospitalization for stroke, report Sunmee Jang (Inje University, Gimhae, Republic of Korea) and colleagues.
Nonadherence had only a small, nonsignificant effect on the likelihood for hospitalization with ischemic heart disease.
The team defined medication adherence as receipt of sufficient antihypertensives to cover at least 80% of the days in a given period. Of 40,408 hypertensive patients identified in the South Korean national insurance database, just 42.4% met this threshold.
The patients had been diagnosed with hypertension in 2003. Over the next 4 years, those who were nonadherent to their medication were a significant 57% more likely than adherent patients to die or be hospitalized for cardiovascular disease. The association was independent of factors including age, gender, baseline cardiovascular risk, and Charlson Comorbidity Index score.
Nonadherence increased the risk for all-cause death by 48%. It increased the risk for cardiovascular disease hospitalization by a smaller 25%, which was composed of a 51% increased risk for stroke hospitalization and a nonsignificant 8% increased risk for being hospitalized with ischemic heart disease.
“Although our results indicate that medication adherence is an important factor for the prevention of adverse health outcomes, the proportion of patients with adherence to long-term care was <50% in the studied population in South Korea,” the researchers comment in Hypertension Research.
In general, older patients with more medical problems were the most likely to be adherent. The likelihood for nonadherence was reduced by 46% in patients aged 45 to 64 years and by 40% in older patients, relative to those younger than 45 years. It was reduced by a significant 34% in those with diabetes, 33% in those with dyslipidemia, and by 21% in those taking at least two, rather than just one, antihypertensive drugs.
However, patients who had previously been admitted to hospital, for any reason, were 35% more likely to be nonadherent than those who had not.
“These findings suggest that intervention programs should be developed and designed to improve medication adherence in patients with low adherence,” concludes the team.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter