Self-reported adherence with medication and cardiovascular disease outcomes in the Second Australian National Blood Pressure Study (ANBP2).
OBJECTIVE
To investigate whether responses to a previously validated four-item medication adherence questionnaire were associated with adverse cardiovascular events.


METHODS
Survey conducted among a cohort of participants in the Second Australian National Blood Pressure Study.


METHODS
Australian general practice.


METHODS
4039 older people with hypertension.


METHODS
All major cardiovascular events or death; first specific cardiovascular event.


RESULTS
Subjects who adhered to their medication regimen (compared with non-adherent subjects) were significantly less likely to experience a first cardiovascular event or a first non-fatal cardiovascular event (hazard ratio [HR] for both, 0.81; 95% CI, 0.67-0.98; P = 0.03); a fatal other cardiovascular event (HR, 0.68; 95% CI, 0.48-0.99; P = 0.04); or a first occurrence of heart failure (HR, 0.58; 95% CI, 0.37-0.90; P = 0.02). Those who answered yes to "Did you ever forget to take your medication?" were significantly more likely to experience a cardiovascular event or death (HR, 1.28; 95% CI, 1.04-1.57; P = 0.02); a first cardiovascular event or death (HR, 1.31; 95% CI, 1.07-1.60; P = 0.01); a first cardiovascular event (HR, 1.34; 95% CI, 1.09-1.65; P = 0.01); or a first non-fatal cardiovascular event (HR, 1.35; 95% CI, 1.09-1.66; P = 0.01). Those who answered yes to "Sometimes, if you felt worse when you took your medicine, did you stop taking it?" were significantly more likely to experience a first occurrence of heart failure (HR, 2.06; 95% CI, 1.16-3.64; P = 0.01).


CONCLUSIONS
Subjects who adhered to their medication regimen were less likely to experience major cardiovascular events or death. The question relating to forgetting to take medication identified non-adherent subjects likely to experience a cardiovascular event or death. Clinicians could use this question to identify patients with hypertension who are likely to benefit from medication adherence strategies.
Nelson
Mark R
MR
Discipline of General Practice, University of Tasmania, Hobart, TAS, Australia. Mark.Nelson@utas.edu.au
Reid
Christopher M
CM
Ryan
Philip
P
Willson
Kristyn
K
Yelland
Lisa
L
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001315:Australia; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D012307:Risk Factors; D012647:Self-Assessment; D016896:Treatment Outcome; D016312:Treatment Refusal
D000959:Antihypertensive Agents