Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients.
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.


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 >or=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, >or=80%), intermediate (proportion of days covered, 40% to 79%), and low (proportion of days covered, <or=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.
Mazzaglia
Giampiero
G
Health Search, Italian College of General Practitioners, Florence, Italy. mazzaglia.giampiero@simg.it
Ambrosioni
Ettore
E
Alacqua
Marianna
M
Filippi
Alessandro
A
Sessa
Emiliano
E
Immordino
Vincenzo
V
Borghi
Claudio
C
Brignoli
Ovidio
O
Caputi
Achille P
AP
Cricelli
Claudio
C
Mantovani
Lorenzo G
LG
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D016208:Databases, Factual; D048909:Diabetes Complications; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010349:Patient Compliance
D000959:Antihypertensive Agents