title: Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes.
abstract: OBJECTIVE
  To evaluate the relationship between antihypertensive (AH) drug adherence and cardiovascular (CV) outcomes among patients with a recent ischemic stroke and assess the validity of our approach.
  
  
  METHODS
  A cohort of 14,227 patients diagnosed with an ischemic stroke was assembled from individuals 65 years and older who were treated with AH agents from 1999 to 2007 in Quebec, Canada. A nested case-control design was used to evaluate the occurrence of nonfatal major CV outcomes and mortality. Each case was matched to 15 controls by age and cohort entry time. Medication possession ratio was used for AH agent adherence level. Adjusted conditional logistic regression models were used to estimate the rate ratio of CV events. The validity of the approach was assessed by evaluating the adherence level of CV-protective and non-CV-protective drugs.
  
  
  RESULTS
  Mean age was 75 years, 54% were male, 38% had coronary artery disease, 23% had diabetes, 47% dyslipidemia, and 14% atrial fibrillation or flutter. High adherence to AH therapy was mirrored by similar adherence to statins and antiplatelet agents and was associated with a lower risk of nonfatal vascular events compared with lower adherence (rate ratio 0.77 [0.70-0.86]). We observed a paradoxic link between adherence to several drugs and all-cause mortality.
  
  
  CONCLUSIONS
  Adherence to AH agents is associated with adherence to other secondary preventive therapies and a risk reduction for nonfatal vascular events after an ischemic stroke. Overestimation of all-cause mortality reduction may be related to frailty and comorbidities, which may confound the apparent benefit of different drugs.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Faculty of Medicine, McGill University, Montreal, Canada. sylvie.perreault@umontreal.ca
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.forename: Amy Y X
authors.initials: AY
authors.lastname: Yu
authors.forename: Robert
authors.initials: R
authors.lastname: Côté
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.forename: Brian
authors.initials: B
authors.lastname: White-Guay
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dumas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000517:prevention & control; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D011792:Quebec; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents