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Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death

James E Bailey1, Jim Y Wan, Jun Tang

  • 1Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman D222, Memphis, TN 38163, USA. jeb@uthsc.edu

Journal of General Internal Medicine
|February 19, 2010
PubMed

Insights

Improving adherence to antihypertensive medications and increasing ambulatory visits significantly reduce stroke and death risks in hypertensive patients. Even a small increase in medication adherence lowers the hazard of stroke and death.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Pharmacoeconomics

Background:

  • Hypertension management is critical for preventing cardiovascular events.
  • Understanding factors influencing outcomes in community-dwelling hypertensive patients is essential.

Purpose of the Study:

  • To investigate the association between antihypertensive medication refill adherence, ambulatory visits, and stroke/death in hypertensive patients.
  • To evaluate the impact of different antihypertensive medication classes on patient outcomes.

Main Methods:

  • Retrospective cohort study of 49,479 hypertensive patients in Tennessee's Medicaid program (1994-2000).
  • Analysis of administrative and pharmacy refill data over 3-7 years.
  • Cox proportional hazards modeling to assess associations with stroke and death.

Main Results:

  • Increased medication adherence was linked to reduced hazards of stroke and death.
  • Higher baseline adherence correlated with a 9% decrease in stroke hazard per 15% adherence increase.
  • Ambulatory visits were associated with decreased mortality; thiazide diuretics specifically reduced stroke risk.

Conclusions:

  • Ambulatory visits and specific antihypertensive medication exposures are associated with reduced mortality.
  • Improving medication adherence by one pill weekly for a daily regimen reduces stroke hazard by 8-9% and death hazard by 7%.
Abstract

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