Adherence to antihypertensive agents improves risk reduction of end-stage renal disease

Abstract

Uncontrolled hypertension is associated with an increased risk of end-stage renal disease (ESRD). Intensified blood pressure control may slow progression of chronic kidney disease; however, the impact of antihypertensive agent adherence on the prevention of ESRD has never been evaluated. Here we assessed the impact of antihypertensive agent adherence on the risk of ESRD in 185,476 patients in the RAMQ databases age 45 to 85 and newly diagnosed/treated for hypertension between 1999 and 2007. A case cohort study design was used to assess the risk of and multivariate Cox proportional models were used to estimate the adjusted hazard ratio of ESRD. Adherence level was reported as a medication possession ratio. Mean patient age was 63 years, 42.2% male, 14.0% diabetic, 30.3% dyslipidemic, and mean follow-up was 5.1 years. A high adherence level of 80% or more to antihypertensive agent(s) compared to a lower one was related to a risk reduction of ESRD (hazard ratio 0.67; 95% confidence intervals 0.54-0.83). Sensitivity analysis revealed that the effect is mainly in those without chronic kidney disease. Risk factors for ESRD were male, diabetes, peripheral artery disease, chronic heart failure, gout, previous chronic kidney disease, and use of more than one agent. Thus, our study suggests that a better adherence to antihypertensive agents is related to a risk reduction of ESRD and this adherence needs to be improved to optimize benefits.

Understanding Antihypertensive Medication Use after Living Kidney Donation through Linked National Registry and Pharmacy Claims Data

“…Claims data are not medical records, and we lacked information on non-pharmacological treatments for hypertension such as lifestyle modifications. The MPR metric used in secondary analyses is an established measure of medication exposure that has been applied to combine AHM use from diverse classes into a single parameter, but does not include dose information given the diversity of agents aggregated within the metric [19,20,21]. Pre-donation insurance benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses was not adequate for inclusion.…”

“…Primary analyses considered time to first fill of any AHM or AHM class, respectively, among the donor sample. In secondary analyses, we computed medication possession ratios (MPRs), a metric quantifying the fraction of days of captured insurance enrollment for which AHM were prescribed [19,20,21]. MPRs were defined as: [days of medication supplied over an observation window]/[days of observation], where observation windows were defined as the period of captured insurance benefits for an individual.…”

“…Pharmacy claims offer a non-obtrusive measure of prescribed healthcare that do not rely on patient self-report and are increasingly used in observational investigations of large populations including transplant-related epidemiologic studies [16,17,18,19,20,21]. To advance understanding of medically treated hypertension after live kidney donation, we examined a linkage of OPTN registry data for living donors with administrative records from a private health insurer that includes pharmacy claims for prescription medications.…”

Facteurs associés à la non-observance chez les hommes et chez les femmes hypertendus non contrôlés : étude ODACE

“…La non-observance au traitement est un enjeu de santé publique en particulier dans les maladies chroniques comme l'hypertension artérielle (HTA). En effet, la non-observance du traitement anti-HTA pourrait aggraver la morbi-mortalité liée à l'HTA [2][3][4][5].…”

The effectiveness and safety of angiotensin-converting enzyme inhibition or receptor blockade in vascular diseases in patients with hemodialysis

“…This study revealed that an MPR ≥80% in a newly diagnosed hypertensive population is associated with a 33% reduction in risk of ESRD onset. [21] A previous study revealed that ACE inhibitor use was lower (50% MPR) in patients with CKD and coronary heart disease events, and CCB use was higher (47% MPR) compared with non-CKD populations (58% MPR for ACEIs and 38% MPRs for CCBs). [22] In our study, hemodialysis patients exhibited a low level of adherence to treatment with ACEIs/ARBs, and less than 10% of patients met criteria for good adherence (MPR ≥80%).…”