Faculty Collaboration Database

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. Hypertension 2016 Jul;68(1):39-45

Date

05/25/2016

Pubmed ID

27217410

Pubmed Central ID

PMC4900942

DOI

10.1161/HYPERTENSIONAHA.115.06960

Scopus ID

2-s2.0-84970044587 (requires institutional sign-in at Scopus site)   75 Citations

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 List

Kronish IM, Lynch AI, Oparil S, Whittle J, Davis BR, Simpson LM, Krousel-Wood M, Cushman WC, Chang TI, Muntner P

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenergic alpha-Antagonists
Aged
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Blood Pressure Determination
Calcium Channel Blockers
Double-Blind Method
Electrocardiography
Female
Follow-Up Studies
Humans
Hypertension
Hypolipidemic Agents
Linear Models
Male
Medication Adherence
Middle Aged
Myocardial Infarction
Office Visits
Patient Selection
Proportional Hazards Models
Risk Assessment
Severity of Illness Index
Treatment Outcome