title: Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications.
abstract: The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16-2.31; P for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28-3.77; P for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25-2.96; P for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Soyeun
authors: S
authors: Kim
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Dong Wook
authors: DW
authors: Shin
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Jae Moon
authors: JM
authors: Yun
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Yunji
authors: Y
authors: Hwang
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Sue K
authors: SK
authors: Park
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.).
authors: Young-Jin
authors: YJ
authors: Ko
authors: From the Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea (S.K., Y.-J.K.); Department of Family Medicine (D.W.S., J.M.Y., B.L.C.) and Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute (D.W.S., J.M.Y., B.L.C.), Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea (D.W.S., J.M.Y., B.L.C.); Advanced Institutes of Convergence Technology, Seoul National University, Suwon-si, Gyeonggi-do, Korea (B.L.C.); Institute on Aging (B.L.C.), Department of Preventive Medicine (Y.H., S.K.P.), and Cancer Research Institute (Y.H., S.K.P.), Seoul National University College of Medicine, Seoul, Korea; and Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea (Y.H., S.K.P.). belong@snu.ac.kr.
authors: BeLong
authors: B
authors: Cho
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055553:Prescription Drugs; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D000959:Antihypertensive Agents; D055553:Prescription Drugs
keywords: antihypertensive agents; cerebral hemorrhage; hospitalization; medication adherence; stroke