Abstract 14289: Drug Adherence and the Incidence of Coronary Heart Disease- and Stroke-Specific Mortality among Patients Newly Prescribed Antihypertensive Medications: A 5-Year Cohort Study
Background: Randomised trials have shown that optimal adherence to antihypertensive could protect against cardiovascular diseases, but whether adherence reduces cardiovascular deaths in community settings has not been as fully explored. This study evaluates the association between antihypertensive adherence and cardiovascular (coronary heart disease and stroke) mortality in outpatient settings.
Methods and Results: From a territory-wide database in Hong Kong, we included all patients prescribed their first-ever antihypertensive agents in the years 2001 to 2005 from the public healthcare sector. All patients were followed-up for 5 years, and assigned as having poor (proportion days covered [PDC] <40%), intermediate (40-79%) and high (≥ 80%) adherence to antihypertensive agents. The association between antihypertensive adherence and cardiovascular mortality was evaluated using Cox proportional hazard models. Patients who died of medical conditions other than cardiovascular causes were excluded. From a total of 218,027 eligible patients, 3,825 patients (1.75%) died of coronary heart disease or stroke within 5 years after having received their first-ever antihypertensive agents. The proportions of patients having poor, intermediate and high medication adherence were 32.9%, 12.1%, 55.0%, respectively. Higher adherence levels at PDC 40%-79% (HR = 0.46, 95% C.I. 0.41-0.52, p<0.001) and ≥ 80% (HR = 0.91, 95% C.I. 0.85-0.98, p=0.012) were significantly less likely to be associated with mortality than the poor adherence (PDC <0.040) group.
Conclusions: Better antihypertensive adherence was associated with lower cardiovascular mortality. This highlights the need to promote adherence through strategies such as patient education and to further develop strategies proven effective in clinic settings.
- © 2012 by American Heart Association, Inc.