The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure

Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Ian M. Kronish, Amy I. Lynch, Suzanne Oparil, Jeff Whittle, Barry R. Davis, Lara M. Simpson, Marie Krousel-Wood, William Cushman, Tara I. Chang, Paul Muntner

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.

Original languageEnglish (US)
Pages (from-to)39-45
Number of pages7
JournalHypertension
Volume68
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Medication Adherence
Antihypertensive Agents
Myocardial Infarction
Blood Pressure
Lipids
Hypertension
Confidence Intervals
Social Adjustment
Mortality
Random Allocation

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure : Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. / Kronish, Ian M.; Lynch, Amy I.; Oparil, Suzanne; Whittle, Jeff; Davis, Barry R.; Simpson, Lara M.; Krousel-Wood, Marie; Cushman, William; Chang, Tara I.; Muntner, Paul.

In: Hypertension, Vol. 68, No. 1, 01.07.2016, p. 39-45.

Research output: Contribution to journalArticle

Kronish, Ian M. ; Lynch, Amy I. ; Oparil, Suzanne ; Whittle, Jeff ; Davis, Barry R. ; Simpson, Lara M. ; Krousel-Wood, Marie ; Cushman, William ; Chang, Tara I. ; Muntner, Paul. / The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure : Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. In: Hypertension. 2016 ; Vol. 68, No. 1. pp. 39-45.
@article{caf32aa65c374f2885767a7f79228f5b,
title = "The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial",
abstract = "Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80{\%} of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95{\%} confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95{\%} confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.",
author = "Kronish, {Ian M.} and Lynch, {Amy I.} and Suzanne Oparil and Jeff Whittle and Davis, {Barry R.} and Simpson, {Lara M.} and Marie Krousel-Wood and William Cushman and Chang, {Tara I.} and Paul Muntner",
year = "2016",
month = "7",
day = "1",
doi = "10.1161/HYPERTENSIONAHA.115.06960",
language = "English (US)",
volume = "68",
pages = "39--45",
journal = "Hypertension",
issn = "0194-911X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure

T2 - Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

AU - Kronish, Ian M.

AU - Lynch, Amy I.

AU - Oparil, Suzanne

AU - Whittle, Jeff

AU - Davis, Barry R.

AU - Simpson, Lara M.

AU - Krousel-Wood, Marie

AU - Cushman, William

AU - Chang, Tara I.

AU - Muntner, Paul

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.

AB - Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.

UR - http://www.scopus.com/inward/record.url?scp=84970044587&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84970044587&partnerID=8YFLogxK

U2 - 10.1161/HYPERTENSIONAHA.115.06960

DO - 10.1161/HYPERTENSIONAHA.115.06960

M3 - Article

VL - 68

SP - 39

EP - 45

JO - Hypertension

JF - Hypertension

SN - 0194-911X

IS - 1

ER -