title: Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study.
abstract: OBJECTIVE
  Antihypertensive drug therapy is a major strategy of stroke prevention among hypertensive patients. The aim of this study was to estimate the excess risk of stroke associated with non-adherence to antihypertensive drug therapy among hypertensive patients.
  
  
  RESULTS
  We conducted a population-based study using records from Finnish national registers for 1 January 1995 to 31 December 2007. Of the 73 527 hypertensive patients aged 30 years or older and without pre-existing stroke or cardiovascular disease, 2144 died from stroke and 24 560 were hospitalized due to stroke during the follow-up. At the 2- and 10-year follow-up after the start of continuous antihypertensive medication, non-adherent patients had 3.81 [95% confidence interval (CI) 2.85-5.10] and 3.01 (95% CI: 2.37-3.83) times higher odds of stroke death when compared with the adherent patients. The corresponding odds ratio (OR) for stroke hospitalization was 2.74 (95% CI: 2.35-3.20) at Year 2 and 1.71 (95% CI: 1.49-1.96) at Year 10. In the stroke-event year, the ORs were higher, 5.68 (95% CI: 5.05-6.39) for stroke death and 1.87 (95% CI: 1.72-2.03) for hospitalization. Among those using agents acting on the renin-angiotensin system combined with diuretics or β-blockers, these ORs were 7.49 (95% CI: 5.62-9.98) and 3.91 (95% CI: 3.23-4.75), respectively. The associations between non-adherence and stroke followed a dose-response pattern--the poorer the adherence, the greater the risk of death and hospitalization due to stroke.
  
  
  CONCLUSIONS
  These data suggest that poor adherence to antihypertensive therapy substantially increases near- and long-term risk of stroke among hypertensive patients.
authors.affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Unioninkatu 38, PO Box 59, 00014 Helsinki, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Herttua
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tabák
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality
chemical_list: D000959:Antihypertensive Agents
keywords: Adherence; Antihypertensive therapy; Hypertension; Mortality; Stroke