Antihypertensive Medication Adherence, Ambulatory Visits, and Risk of Stroke and Death

作者：Bailey James E^*; Wan Jim Y; Tang Jun; Ghani Muhammad A; Cushman William C

来源：Journal of General Internal Medicine, 2010, 25(6): 495-503.

DOI：10.1007/s11606-009-1240-1

• hypertension
• ambulatory care
• adherence
• stroke
• thiazide diuretics

This study seeks to determine whether antihypertensive medication refill adherence, ambulatory visits, and type of antihypertensive medication exposures are associated with decreased stroke and death for community-dwelling hypertensive patients.
This retrospective cohort study included all chronic medication-treated hypertensives enrolled in Tennessee's Medicaid program (TennCare) for 3-7 years during the period 1994-2000 (n = 49,479). Health care utilization patterns were evaluated using administrative data linked to vital records during a 2-year run-in period and 1- to 5-year follow-up period. Antihypertensive medication refill adherence was calculated using pharmacy records.
Associations with stroke and death were assessed using Cox proportional hazards modeling. Stroke occurred in 619 patients (1.25%) and death in 2,051 (4.15%). Baseline antihypertensive medication refill adherence was associated with decreased multivariate hazards of stroke [hazard ratio (HR) 0.91; 95% confidence interval (CI), 0.86-0.97 for 15% increase in adherence]. Adherence in the follow-up period was associated with decreased hazards of stroke (HR 0.92; CI 0.87-0.96) and death (HR 0.93; CI 0.90-0.96). Baseline ambulatory visits were associated with decreased death (HR 0.99; CI 0.98-1.00). Four major classes of antihypertensive agents were associated with mortality reduction. Only thiazide-type diuretic use was associated with decreased stroke (HR 0.89; CI 0.85-0.93).
Ambulatory visits and antihypertensive medication exposures are associated with reduced mortality. Increasing adherence by one pill per week for a once-a-day regimen reduces the hazard of stroke by 8-9% and death by 7%.

• 出版日期2010-6