title: Adherence with antihypertensive drug therapy and the risk of heart failure in clinical practice.
abstract: Randomized clinical trials have shown that antihypertensive treatment reduces the risk of heart failure (HF). Limited evidence exists, however, on whether and to what extent this benefit is translated into real-life practice. A nested case-control study was carried out by including the cohort of 76 017 patients from Lombardy (Italy), aged 40 to 80 years, who were newly treated with antihypertensive drugs during 2005. Cases were the 622 patients who experienced hospitalization for HF from initial prescription until 2012. Up to 5 controls were randomly selected for each case. Logistic regression was used to model the HF risk associated with adherence to antihypertensive drugs, which was measured by the proportion of days covered by treatment (PDC). Data were adjusted for several covariates. Sensitivity analyses were performed to account for possible sources of systematic uncertainty. Compared with patients with very low adherence (PDC, ≤25%), low, intermediate, and high adherences were associated with progressively lower risk of HF, reduction in the high-adherence group (>75%) being 34% (95% confidence interval, 17%-48%). Similar effects were observed in younger (40-70 years) and older (71-80 years) patients and between patients treated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. There was no evidence that adherence with calcium-channel blockers reduced the HF risk. Antihypertensive treatment lowers the HF risk in real-life practice, but adherence to treatment is necessary for a substantial benefit to take place. This is the case with a variety of antihypertensive drugs.
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.). giovanni.corrao@unimib.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.).
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.).
authors.forename: Arianna
authors.initials: A
authors.lastname: Ghirardi
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.).
authors.forename: Davide
authors.initials: D
authors.lastname: Soranna
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.).
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.affiliation: From the Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (G.C., F.R., A.G., D.S.), Department of Life Science (G.M.), University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy (D.S., G.M.); and Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy (L.M.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
keywords: antihypertensive agents; heart failure; medical record linkage; medication adherence