title: Medication adherence and stroke/TIA risk in treated hypertensives: results from the REGARDS study.
abstract: BACKGROUND
  The extent to which low medication adherence in hypertensive individuals contributes to disparities in stroke and transient ischemic attack (TIA) risk is poorly understood.
  
  
  METHODS
  Investigators examined the relationship between self-reported medication adherence and blood pressure (BP) control (<140/90 mm Hg), Framingham Stroke Risk Score, and physician-adjudicated stroke/TIA incidence in treated hypertensive subjects (n = 15,071; 51% black; 57% in Stroke Belt) over 4.9 years in the national population-based REGARDS cohort study.
  
  
  RESULTS
  Mean systolic BP varied from 130.8 ± 16.2 mm Hg in those reporting high adherence to 137.8 ± 19.5 mm Hg in those reporting low adherence (P for trend < .0001). In logistic regression models, each level of worsening medication adherence was associated with significant and increasing odds of inadequately controlled BP (≥140/90 mm Hg; score = 1, odds ratio [95% confidence interval], 1.20 [1.09-1.30]; score = 2, 1.27 [1.08-1.49]; score = 3 or 4, 2.21 [1.75-2.78]). In hazard models using systolic BP as a mediator, those reporting low medication adherence had 1.08 (1.04-1.14) times greater risk of stroke and 1.08 (1.03-1.12) times greater risk of stroke or TIA.
  
  
  CONCLUSIONS
  Low medication adherence was associated with inadequate BP control and an increased risk of incident stroke or TIA.
authors.affiliation: Brody School of Medicine at East Carolina University, Greenville, NC. Electronic address: cummingsd@ecu.edu.
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Letter
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Valerie
authors.initials: V
authors.lastname: Prince
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology*; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000208:ethnology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D015144:Southeastern United States / Q000453:epidemiology; D020521:Stroke / Q000208:ethnology* / Q000517:prevention & control; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents
keywords: Medication adherence; blood pressure control; stroke; transient ischemic attack
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