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(Circulation. 2009;120:1598-1605.)
© 2009 American Heart Association, Inc.

Hypertension

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

Giampiero Mazzaglia, MD, PhD; Ettore Ambrosioni, MD, PhD; Marianna Alacqua, MD; Alessandro Filippi, MD; Emiliano Sessa, DSc; Vincenzo Immordino, MD; Claudio Borghi, MD; Ovidio Brignoli, MD; Achille P. Caputi, MD; Claudio Cricelli, MD; Lorenzo G. Mantovani, MSc, DSc

From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy.

Correspondence to Giampiero Mazzaglia, MD, PhD, Health Search, Italian College of General Practitioners, Largo Cesare Cantù 8, 50143, Florence, Italy. E-mail mazzaglia.giampiero{at}simg.it

Received October 20, 2008; accepted July 29, 2009.

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.

Methods and Results— Using data obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database, we selected 18 806 newly diagnosed hypertensive patients 35 years of age during the years 2000 to 2001. Subjects included were newly treated for hypertension and initially free of cardiovascular diseases. Patient adherence was subdivided a priori into 3 categories—high (proportion of days covered, 80%), intermediate (proportion of days covered, 40% to 79%), and low (proportion of days covered, 40%)—and compared with the long-term occurrence of acute cardiovascular events through the use of multivariable models adjusted for demographic factors, comorbidities, and concomitant drug use. At baseline (ie, 6 months after index diagnosis), 8.1%, 40.5%, and 51.4% of patients were classified as having high, intermediate, and low adherence levels, respectively. Multiple drug treatment (odds ratio, 1.62; 95% CI, 1.43 to 1.83), dyslipidemia (odds ratio, 1.52; 95% CI, 1.24 to 1.87), diabetes mellitus (odds ratio, 1.40; 95% CI, 1.15 to 1.71), obesity (odds ratio, 1.50; 95% CI, 1.26 to 1.78), and antihypertensive combination therapy (odds ratio, 1.29; 95% CI, 1.15 to 1.45) were significantly (P<0.001) associated with high adherence to antihypertensive treatment. Compared with their low-adherence counterparts, only high adherers reported a significantly decreased risk of acute cardiovascular events (hazard ratio, 0.62; 95% CI, 0.40 to 0.96; P=0.032).

Conclusions— The long-term reduction of acute cardiovascular events associated with high adherence to antihypertensive treatment underscores its importance in assessments of the beneficial effects of evidence-based therapies in the population. An effort focused on early antihypertensive treatment initiation and adherence is likely to provide major benefits.

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CLINICAL PERSPECTIVE

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