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Published on: January 18, 2018

Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes

Sylvie Perreault1, Amy Y X Yu, Robert Côté

  • 1Faculty of Pharmacy, University of Montreal, Faculty of Medicine, McGill University, Montreal, Canada. sylvie.perreault@umontreal.ca

Neurology
|November 2, 2012
PubMed

Insights

High adherence to antihypertensive (AH) drugs after ischemic stroke is linked to fewer vascular events. However, the association with reduced mortality may be confounded by patient frailty and comorbidities.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Adherence to antihypertensive (AH) therapy is crucial for secondary prevention after ischemic stroke.
  • Understanding the impact of AH drug adherence on cardiovascular (CV) outcomes and mortality is essential for optimizing patient care.
  • Assessing the validity of adherence metrics is important for reliable research findings.

Purpose of the Study:

  • To evaluate the relationship between antihypertensive (AH) drug adherence and cardiovascular (CV) outcomes in patients with recent ischemic stroke.
  • To assess the validity of the adherence measurement approach used in the study.

Main Methods:

  • A cohort of 14,227 patients aged 65+ with ischemic stroke treated with AH agents (1999-2007) in Quebec, Canada, was analyzed.
  • A nested case-control design was employed to assess nonfatal CV outcomes and mortality.
  • Medication possession ratio (MPR) was used to determine AH agent adherence levels, with validity assessed using CV-protective and non-CV-protective drugs.

Main Results:

  • High adherence to AH therapy correlated with similar adherence to statins and antiplatelet agents.
  • High adherence to AH therapy was associated with a reduced risk of nonfatal vascular events (rate ratio 0.77 [0.70-0.86]).
  • A paradoxical association was observed between adherence to certain drugs and all-cause mortality.

Conclusions:

  • Adherence to antihypertensive agents signifies adherence to other secondary preventive therapies, reducing nonfatal vascular event risk post-stroke.
  • The apparent benefit of different drugs on all-cause mortality may be overestimated due to confounding factors like frailty and comorbidities.
Abstract

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