Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate

Martin, Guy; Patel, Nandesh; Grant, Yasmin; Jenkins, Michael; Gibbs, Richard; Bicknell, Colin

doi:10.1016/j.jvs.2017.12.063

Cited by 25 publications

(17 citation statements)

References 39 publications

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“…Morisky Medication Adherence scale scores were distributed into high (41.4%), intermediate (33.6%), and low (25.0%) adherence. This distribution was relatively consistent with prior studies indicating overall high rates of nonadherence to prescribed medications, [7][8][9][10][11] although variation can be attributed to differences in definition, measurement of adherence, and patient population. A study by Martin et al similarly used MMAS-8 to measure adherence to antihypertensives in chronic type B aortic dissection patients and found a remarkably analogous distribution at high (43%), intermediate (36%), and low (21%) adherence.…”

Section: Discussionsupporting

confidence: 87%

“…A study by Martin et al similarly used MMAS-8 to measure adherence to antihypertensives in chronic type B aortic dissection patients and found a remarkably analogous distribution at high (43%), intermediate (36%), and low (21%) adherence. 10 Younger age was significantly associated with low adherence. This is similar to a cardiology study that identified age <65 as an independent predictor of low adherence, 13 and another vascular study that demonstrated younger patients were less adherent to American Heart Association/American College of Cardiology (AHA/ACC) guideline-recommended therapies: aspirin, statin, angiotensin-converting enzyme inhibitor, and smoking cessation.…”

Section: Discussionmentioning

confidence: 96%

“…3,4 Unfortunately, patients with vascular disease also have a high rate of medication nonadherence, often in more than half the population. [7][8][9][10][11] Prior studies have reported nonadherence in various types of vascular disease 7 and have measured adherence through pharmacy prescriptions or available databases, [7][8][9] self-reported measures such as surveys, 10 or direct biochemical analysis. 11 However, little is known about patient factors that contribute to or correlate with poor medication adherence.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Medication Adherence in Vascular Surgery Patients

Minami

Zemela

Ring

et al. 2020

Vasc Endovascular Surg

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Introduction: Patients with vascular disease have higher mortality rates than age-matched peers and medical management of coexisting diseases may alter these outcomes. We sought to understand factors associated with medication nonadherence in vascular surgery patients at a single University vascular surgery clinic over a 3-month period. Materials and Methods: Consecutive vascular surgery patients were surveyed from June to August 2019. The survey included demographic questions, the validated Morisky Medication Adherence Scale, the 4-item Patient Health Questionnaire for Anxiety and Depression scales, and other medication-related questions. Medical and surgical histories were retrospectively collected from charts. Univariate and multivariate analyses were used to compare among high, intermediate, and low adherence. Results: A total of 128 (74%) of 174 patients met study inclusion criteria. On univariate analysis, lower medication adherence was associated with younger age ( P = .004), anxiety and depression ( P = .001), higher daily pain ( P < .001), and patients who believed their medications were less important for treating their vascular disease ( P < .001). Adherence was not associated with symptomatic vascular disease, gender, education level, marital status, employment, insurance, or the use of medication usage reminders. Multivariate analysis significantly predicted high adherence relative to low adherence with 5-year increase in age (odds ratio [OR] = 1.252, P = .021) and low adherence relative to high adherence with greater perceived pain (OR = 0.839, P = .016). Conclusions: Younger age and high level of pain were associated with lower medication adherence. Informing patients of the importance of prescribed medication and addressing anxiety or depression symptoms may improve adherence.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Medication Adherence in Vascular Surgery Patients

Minami

Zemela

Ring

et al. 2020

Vasc Endovascular Surg

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“…The importance of good blood pressure control cannot be overestimated as the major component of conservative management; from trials such as the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) and Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB), we have learned that the majority of patients required at least three different antihypertensive medications to achieve a satisfactory blood pressure control [16]. Moreover, a recent observational study performed outside of a trial setting demonstrated that the majority of patients adhere poorly to a combination antihypertensive therapy [17]. Guidelines from the American College of Cardiology and the European Society of Cardiology suggest further studies should be undertaken to refine the therapeutic approaches required for early medical management in patients with type B aortic dissection [8,11].…”

Section: Optimal Medical Treatment (Omt)mentioning

confidence: 99%

Management of Uncomplicated Type B Aortic Dissection

Yuan

Clough

Nienaber

2020

Hearts

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Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days.

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“…64,65 Unfortunately, adherence to anti-hypertensive medications is an issue. 66 CTA is the imaging of choice. In younger patients, especially lifetime radiation exposure because of multiple CTA should be considered in follow-up imaging.…”

Section: Follow-upmentioning

confidence: 99%

Management of acute type B aortic dissection

Munshi

Ritter

Doyle

et al. 2020

ANZ Journal of Surgery

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Background: The best management of acute uncomplicated type B aortic dissection is currently a controversial area. Recent advances in endovascular intervention have begun to establish pre-emptive thoracic endovascular aortic repair as a potential strategy. A review about the management for type B aortic dissection has been conducted. Methods: A narrative review consisting of 157 original articles, meta-analyses and guidelines was conducted. The findings were synthesized and summarized using 70 articles. Results: There are clear guidelines directing surgical management of acute complicated type B aortic dissection. However, the best management of acute uncomplicated disease is more ambiguous, which is especially concerning in a condition which is associated with significant morbidity and mortality. Medical management alone is generally favoured. Endovascular intervention is now being considered by some surgeons, but it can be technically difficult, while exposing the patient to potential surgical risks. Conclusions: Clinical and anatomical risk factors have been identified to help vascular surgeons make decisions about treatment in acute uncomplicated type B aortic dissection. New endovascular strategies are being developed to reduce surgical risk and address technical challenges. Registry data should be used to support future best management.

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Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate

Cited by 25 publications

References 39 publications

Factors Associated With Medication Adherence in Vascular Surgery Patients

Factors Associated With Medication Adherence in Vascular Surgery Patients

Management of Uncomplicated Type B Aortic Dissection

Management of acute type B aortic dissection

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