Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension

Abstract

Treatment and control rates for high blood pressure are unsatisfactory in young adults. Adherence to pharmacological treatment is alarmingly low, with absence of data on its consequences in young adults with hypertension. We investigated the association of antihypertensive medication nonadherence with incident cardiovascular events among young adults initiating pharmacological treatment for hypertension. From a nationwide health insurance database, we included 123 390 participants (75.1% male) of age 20 to 44 years, free of prior cardiovascular disease (CVD), who initiated pharmacological treatment for hypertension from 2004 through 2007. Participants were categorized as either adherent (proportion of days covered ≥0.8; n=45 350) or nonadherent (proportion of days covered <0.8; n=78 040) to antihypertensive medication during the first year of treatment. The primary outcome was composite CVD events, including myocardial infarction, stroke, heart failure, and cardiovascular death. Over a median follow-up of 10 years, 3002 new CVD events occurred. CVD incidence rates per 100 000 person-years were 191.0 in the adherent group and 282.1 in the nonadherent group. Multivariable-adjusted hazard ratio for CVD events associated with nonadherence versus adherence was 1.57 (95% CI, 1.45–1.71). There was a dose-response association between medication adherence (in quartiles or continuous proportion of days covered) and CVD risk. In conclusion, among young adults who initiated pharmacological treatment for high blood pressure, poor medication adherence was associated with higher risk for future CVD events.

Hypertension perspectives and health behaviors of African youth: The effect of health education and employment

“…Our results also showed that young adults generally fear embarking on lifelong medication use. This is consistent with other research and suggests that medication adherence in young adults is generally low, 18,54,55 and medication side-effects are the main barrier to adherence in young adults with HTN. 18 Additionally, individuals who default on taking antihypertensive medication perceive no immediate negative health consequences, 18 potentially reinforcing the decision to not take treatment.…”

“…This assessment is critical in a country where two out of three young adults are unemployed. 35 Additionally, while a number of studies have analyzed risk factors, perceptions and self-care behaviors among young people already diagnosed with HTN, 12,18,54,55,64,65 this study focused on preventive measures in young adults without a known diagnosis in which prevention efforts may be most beneficial.…”

Association between high-mobility group box 2 and subclinical hypertension-mediated organ damage in young adults

“…The blood pressure (BP) measurement protocol suggested at least 5 min of rest in a seated position followed by two repeated measurements at 5-min intervals. 4 , 24 Clinic BP measurements were consecutively performed 3 times at clinic visits by trained medical staff using an HEM-1000 BP monitor (Omron Healthcare). Ambulatory BP monitoring was measured using the same type of ambulatory BP monitor (ABPM 6100; Welch Allyn) for each participant.…”

“… 1 , 2 Hypertension in young adults has attracted increasing concern, as it can increase their risk of cardiometabolic disease and stroke. 3 , 4 Even though hypertension-mediated organ damage (HMOD) commonly appears clinically at midlife and later, its onset can occur in young adulthood. 5 – 7 Subtle HMOD, such as left ventricular hypertrophy (LVH), microalbuminuria, cognitive dysfunction, and thickening of the carotid vessel wall, is detectable early in the development of hypertensive cardiovascular disease (CVD).…”

“…Young individuals with hypertension may have distinct characteristics, and the pathophysiologic characteristics of hypertension may differ between older and younger individuals. 2 – 4 Chronic immune-mediated inflammation is increasingly recognized as an important contributor to HMOD. Thus, the early exploration for hypertension-related inflammatory biomarkers in young individuals may provide a more sensitive and adequate measure for identifying early cardiovascular risk, especially for those individuals who are asymptomatic.…”