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Antihypertensive medication adherence and cardiovascular disease risk: A longitudinal cohort study

Jiqing Li1, Zhentang Zhang2, Shucheng Si1

  • 1Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China; Healthcare Big Data Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.

Atherosclerosis
|January 30, 2021
PubMed

Insights

Poor adherence to blood pressure medication significantly increases cardiovascular disease (CVD) risk. This study highlights that consistent antihypertensive adherence is crucial for managing blood pressure and preventing CVD events.

Area of Science:

  • Cardiology
  • Public Health
  • Pharmacology

Background:

  • Cardiovascular diseases (CVD) pose a significant health burden.
  • Estimating the impact of antihypertensive adherence on CVD in longitudinal cohorts with time-dependent confounders is challenging.
  • Understanding medication adherence is vital for effective hypertension management.

Purpose of the Study:

  • To assess the association between antihypertensive adherence and CVD events using marginal structural Cox models (MSM-Cox).
  • To characterize blood pressure (BP) trajectories in hypertensive patients with varying adherence levels.
  • To provide a more accurate estimation of adherence impact compared to conventional methods.

Main Methods:

  • A longitudinal cohort study of 16,896 hypertensive patients.
  • Utilized marginal structural Cox models (MSM-Cox) and standard Cox models.
  • Employed linear mixed-effects models to analyze blood pressure trajectories and BP burden (AUC).

Main Results:

  • Low antihypertensive adherence was associated with a 75% increased risk of CVD (HR: 1.75) using MSM-Cox.
  • Crude CVD incidence was higher in low-adherence groups (112.6 vs. 80.8 per 1000 person-years).
  • Low adherence led to greater BP burden and fluctuation, with high adherence patients showing a 28% greater BP burden reduction.

Conclusions:

  • Antihypertensive adherence shows a stronger association with CVD risk than previously estimated by conventional analyses.
  • Consistent medication adherence is a critical factor in mitigating CVD risk.
  • MSM-Cox models offer a more robust approach to evaluating adherence impact in the presence of time-dependent confounders.
Abstract

Keywords:
Cardiovascular diseaseHypertensionMSM-Cox modelMedication adherenceTime-dependent confounder

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