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Association Between Self-Rated Medication Adherence and Adverse Cardiovascular Outcomes in Patients With Hypertension
Shirin Ibrahim1, Nick S Nurmohamed1,2, Didier Collard1
1Department of Vascular Medicine, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands.
Insights
Self-rated medication adherence effectively identifies patients with lower adherence, linking it to poorer blood pressure control, higher LDL cholesterol, and increased cardiovascular events and mortality.
Area of Science:
- Cardiovascular Medicine
- Clinical Pharmacy
- Public Health
Background:
- Medication nonadherence is a significant barrier to effective treatment, leading to adverse health outcomes.
- Identifying nonadherence poses a clinical challenge, impacting patient management and health system efficiency.
- The Systolic Blood Pressure Intervention Trial (SPRINT) provided a unique dataset to investigate adherence.
Purpose of the Study:
- To assess the association between self-rated medication adherence and key health indicators.
- To determine if self-reported adherence predicts systolic blood pressure (SBP) control.
- To evaluate the relationship between self-rated adherence and low-density lipoprotein cholesterol (LDL-C) levels, cardiovascular events, and all-cause mortality.
Main Methods:
- Utilized data from 9278 SPRINT participants with repeated self-rated adherence measurements over 3.8 years.
- Defined lower adherence as scores ≤80% and high adherence as >80% on a 0-100% scale.
- Employed linear mixed-effects regression for SBP and LDL-C, and Cox proportional hazards models for events and mortality.
Main Results:
- Lower adherence was significantly associated with higher on-treatment SBP in both intensive and standard treatment arms.
- Patients with lower adherence exhibited higher LDL-C levels (estimated 11 mg/dL increase).
- Lower adherence correlated with increased risk of cardiovascular events (HR 1.69) and all-cause mortality (HR 1.63).
Conclusions:
- Self-rated adherence is a practical tool for identifying patients with suboptimal medication adherence.
- Self-reported adherence strongly correlates with objective clinical outcomes, including blood pressure control and lipid levels.
- Identifying nonadherent patients via self-rating can help mitigate risks of cardiovascular events and mortality.
Background:
Medication nonadherence contributes to poor health outcomes but remains challenging to identify. This study assessed the association between self-rated adherence and systolic blood pressure, low-density lipoprotein cholesterol levels, cardiovascular events, and all-cause mortality in SPRINT (Systolic Blood Pressure Intervention Trial).
Methods And Results:
A total of 9361 patients randomized to 2 systolic blood pressure target groups, <120 mm Hg (intensive) and <140 mm Hg (standard), self-rated their medication adherence at each visit by marking a scale, ranging from 0% to 100%. Lower and high adherence were defined as scores ≤80% and >80%, respectively. Linear mixed effect regression models and Cox proportional hazard models were used to evaluate the association between self-rated adherence and systolic blood pressure and low-density lipoprotein cholesterol and cardiovascular events and all-cause mortality, respectively. A total of 9278 participants (mean age 68±9.4 years, 35.6% female) had repeated self-rated adherence measurements available, with a mean of 15±4 measurements per participant over 3.8 years follow-up. Of these, 2694 participants (29.0%) had ≥1 adherence measurements ≤80%. Compared with high-adherent patients, patients with lower adherence had significantly higher estimated on-treatment systolic blood pressure at 2-year follow-up: 128.7 (95% CI, 127.6-129.9) versus 120.0 (95% CI, 119.7-120.2) mm Hg in the intensive arm; and 139.8 (95% CI 138.4-141.1) versus 135.0 (95% CI 134.7-135.2) in the standard arm. Moreover, lower adherence was associated with an estimated 11 mg/dL higher low-density lipoprotein cholesterol level, more cardiovascular events (hazard ratio [HR], 1.69 [95% CI, 1.20-2.39]), and higher all-cause mortality (HR, 1.63 [95% CI, 1.16-2.31]).
Conclusions:
Self-rated adherence allows identification of lower medication adherence and correlates with blood pressure control, low-density lipoprotein cholesterol levels, and adverse outcomes.
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