Consequences of Non-Adherence in Treated Hypertensives
December 1, 2013 less than 1 minute read
The relationship between elevated blood pressure (BP) and stroke is linear and continuous. An abundance of clinical trial data indicate that treatment of hypertension (HTN) by means of numerous diverse classes of antihypertensives lowers stroke risk by ≥ 40%. Clinical trials, however, are not “real life.” The Reasons for Geographic and Racial Disparities in Stroke (REGARDS) study is examining a large population (n = 30,239) of southeastern men and women with HTN. Their assessment of the relationship between self-reported degree of antihypertensive medication adherence and serious outcomes (stroke/TIA) from a subset population (n = 15,071) is quite sobering.
During a 5-year window of observation, study participants were grouped into four categories of adherence using the Morisky scale, which translates into general groupings of high, good, moderate, and low adherence. Perhaps not surprisingly, mean systolic BP in the high adherence group was substantially better than the low adherence group (131 mmHg vs 138 mmHg). Incidence of stroke or TIA was 8% higher in the lowest adherence group compared to the highest. Good BP control has meaningful payoff; every decrement of adherence less than that is costly.
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