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

James Bailey, Jim Wan, Jun Tang, Muhammad A. Ghani, William Cushman

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Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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%.

Original languageEnglish (US)
Pages (from-to)495-503
Number of pages9
JournalJournal of General Internal Medicine
Volume25
Issue number6
DOIs
StatePublished - Jun 1 2010

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Medication Adherence
Antihypertensive Agents
Stroke
Confidence Intervals
Patient Acceptance of Health Care
Independent Living
Sodium Chloride Symporter Inhibitors
Mortality
Medicaid
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death. / Bailey, James; Wan, Jim; Tang, Jun; Ghani, Muhammad A.; Cushman, William.

In: Journal of General Internal Medicine, Vol. 25, No. 6, 01.06.2010, p. 495-503.

Research output: Contribution to journalArticle

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