title: Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial.
abstract: Lower adherence to antihypertensive medications may increase visit-to-visit variability of blood pressure (VVV of BP), a risk factor for cardiovascular events and death. We used data from the African American Study of Kidney Disease and Hypertension (AASK) trial to examine whether lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive chronic kidney disease (CKD). Determinants of VVV of BP were also explored. AASK participants (n=988) were categorized by self-report or pill count as having perfect (100%), moderately high (75-99%), moderately low (50-74%) or low (<50%) proportion of study visits with high medication adherence over a 1-year follow-up period. We used multinomial logistic regression to examine determinants of medication adherence, and multivariable-adjusted linear regression to examine the association between medication adherence and systolic VVV of BP, defined as the coefficient of variation or the average real variability (ARV). Participants with lower self-reported adherence were generally younger and had a higher prevalence of comorbid conditions. Compared with perfect adherence, moderately high, moderately low and low adherence was associated with 0.65% (±0.31%), 0.99% (±0.31%) and 1.29% (±0.32%) higher systolic VVV of BP (defined as the coefficient of variation) in fully adjusted models. Results were qualitatively similar when using ARV or when using pill counts as the measure of adherence. Lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive CKD; efforts to improve medication adherence in this population may reduce systolic VVV of BP.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Hong
authors.affiliation: Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physician & Surgeons, New York, NY, USA.
authors.forename: I
authors.initials: I
authors.lastname: Kronish
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Shilane
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: T I
authors.initials: TI
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000208:ethnology / Q000503:physiopathology*; D057566:Self Report; D013599:Systole
chemical_list: D000959:Antihypertensive Agents
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