Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes

Perreault, Sylvie; Yu, Amy Y.X.; Côté, Robert; Dragomir, Alice; White-Guay, Brian; Dumas, S.

doi:10.1212/wnl.0b013e3182749e56

Cited by 46 publications

(52 citation statements)

References 41 publications

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“…Concerning stroke, medication adherence can vary from 45 to 90% [4,5,6,7,8,9]. It has been proven that poor adherence results in poor treatment outcomes [7,10,11]. Therefore, it is essential to improve secondary preventive medication adherence among stroke survivors.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

Bauler¹,

Jacquin-Courtois²,

Haesebaert³

et al. 2014

Eur Neurol

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Objective: To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. Method: A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. Results: Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of overmedication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. Conclusion: This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.

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Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

Bauler¹,

Jacquin-Courtois²,

Haesebaert³

et al. 2014

Eur Neurol

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“…Furthermore, patients with undeclared/unrecognised non-adherence frequently undergo numerous additional (sometimes invasive and often expensive) diagnostic tests in specialist centres to identify causes of their apparent poor response to antihypertensive medications. Moreover, patients who are non-adherent to antihypertensive treatment fail to gain the proven benefits of BP lowering therapy and remain at high risk of cardiovascular events 4 5…”

mentioning

confidence: 99%

High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis

Tomaszewski

White

Patel

et al. 2014

Heart

344

258

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ObjectivesNon-adherence to therapy is an important cause of suboptimal blood pressure control but few practical tools exist to accurately and routinely detect it. We used a simple urine-based assay to evaluate the prevalence of antihypertensive treatment non-adherence and its impact on blood pressure in a specialist hypertension centre.Methods208 hypertensive patients (125 new referrals, 66 follow-up patients with inadequate blood pressure control and 17 renal denervation referrals) underwent assessment of antihypertensive drug intake using high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis at the time of clinical appointment. A total of 40 most commonly prescribed antihypertensive medications (or their metabolites) were screened for in spot urine samples.ResultsOverall, 25% of patients were totally or partially non-adherent to antihypertensive treatment (total non-adherence 10.1%, partial non-adherence 14.9%). The highest prevalence of partial and total non-adherence was among follow-up patients with inadequate blood pressure control (28.8%) and those referred for consideration of renal denervation (23.5%), respectively. There was a linear relationship between blood pressure and the numerical difference in detected/prescribed antihypertensive medications—every unit increase in this difference was associated with 3.0 (1.1) mm Hg, 3.1 (0.7) mm Hg and 1.9 (0.7) mm Hg increase in adjusted clinic systolic blood pressure, clinic diastolic blood pressure (DBP) and 24 h mean daytime DBP (p=0.0051, p=8.62×10−6, p=0.0057), respectively.ConclusionsNon-adherence to blood pressure lowering therapy is common, particularly in patients with suboptimal blood pressure control and those referred for renal denervation. HP LC-MS/MS urine analysis could be used to exclude non-adherence and better stratify further investigations and intervention.

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“…The included studies focussed on a wide range of disease areas including pulmonary diseases, osteoporosis, depression, cardiovascular diseases, Parkinson's disease, epilepsy, chronic kidney disease, cancer and diabetes mellitus . Two studies did not measure disease‐specific medication (non‐)adherence .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies did not measure disease‐specific medication (non‐)adherence . Thirty‐six studies were specific to, or provided age stratified analysis for people aged ≥64 years, while the other 30 studies also included middle aged adults (≥50 years) . Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied. In terms of adherence measurement, 54 studies measured medication (non‐)adherence using pharmacy claims data while 11 studies used self‐report methods, consisting of the 4‐item or 8‐item Morisky Medication Adherence Scale, or self‐reported PDC and MEMs was used in 4 studies …”

Section: Resultsmentioning

confidence: 99%

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The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Walsh

Cahir

Tecklenborg

et al. 2019

Brit J Clinical Pharma

139

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Aims The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years. Methods Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). Results Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). Conclusion Medication non‐adherence may be significantly associated with all‐cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

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Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes

Cited by 46 publications

References 41 publications

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

Barriers and Facilitators for Medication Adherence in Stroke Patients: A Qualitative Study Conducted in French Neurological Rehabilitation Units

High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

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