Do socioeconomic disparities affect accessing and keeping antihypertensive drug therapy? Evidence from an Italian population-based study

Corrao, Giovanni; Zambon, Antonella; Parodi, A. Ferretto; Mezzanzanica, Mario; Merlino, Luca; Cesana, Giancarlo; Mancia, Giuseppe

doi:10.1038/jhh.2008.84

Cited by 26 publications

(23 citation statements)

References 33 publications

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“…Two, economical and social factors (such as the size of the families) are also unlikely to be involved because in Italy, discontinuation of antihypertensive treatment does not appear to be related to patient income and household composition [46]. It is possible, on the contrary, that the greater prevalence of immigrants living in metropolitan areas plays a role because in this fraction of the population, treatment discontinuation has been shown to be greater [46]. We can also speculate that in rural areas, where the population density is low, it is easier for the patient to establish with the doctor a more regular and effective relationship with a favourable impact on treatment adherence.…”

Section: Discussionmentioning

confidence: 96%

“…One, this phenomenon cannot be due to a reduced accessibility to pharmacies, a factor related to lower adherence to treatment in previous studies [45], because in Italy, pharmacies are more numerous in cities than in the country. Two, economical and social factors (such as the size of the families) are also unlikely to be involved because in Italy, discontinuation of antihypertensive treatment does not appear to be related to patient income and household composition [46]. It is possible, on the contrary, that the greater prevalence of immigrants living in metropolitan areas plays a role because in this fraction of the population, treatment discontinuation has been shown to be greater [46].…”

Section: Discussionmentioning

confidence: 97%

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Factors involved in the discontinuation of antihypertensive drug therapy

Mancia

Zambon

Soranna

et al. 2014

Journal of Hypertension

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Factors involved in the discontinuation of antihypertensive drug therapy

Mancia

Zambon

Soranna

et al. 2014

Journal of Hypertension

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“…However, we have reported recently from the Lombardy database that the chance of starting with a combination of 2 drugs, rather than with monotherapy, is substantially independent by patient income. 28 In summary, our data on real-world drug use offer evidence that antihypertensive therapy with a combination of drugs reduces the risk of CV outcomes with respect to treatment with 1 drug only. They also offer evidence that this is the case when combination treatment is used as first-step therapy compared with patients in whom it is used after initial monotherapy.…”

Section: Corrao Et Al Combination Therapy In Hypertension 569mentioning

confidence: 99%

Cardiovascular Protection by Initial and Subsequent Combination of Antihypertensive Drugs in Daily Life Practice

Corrao

Nicotra²,

Parodi³

et al. 2011

Hypertension

114

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Abstract-Guidelines recommend a combination of 2 drugs to be used as first-step treatment strategy in high-risk hypertensive individuals to achieve timely blood pressure control and avoid early events. The evidence that this is associated with cardiovascular (CV) benefits compared with initial monotherapy is limited, however. The objective of this study was to assess whether, compared with antihypertensive monotherapy, a combination of antihypertensive drugs provides a greater CV protection in daily clinical practice. A population-based, nested case-control study was carried out by including the cohort of 209 650 patients from Lombardy (Italy) aged 40 to 79 years who were newly treated with antihypertensive drugs between 2000 and 2001. Cases were the 10 688 patients who experienced a hospitalization for CV disease from initial prescription until 2007. Three controls were randomly selected for each case. Logistic regression was used to model the CV risk associated with starting on and/or continuing with combination therapy. A Monte-Carlo sensitivity analysis was performed to account for unmeasured confounders. Patients starting on combination therapy had an 11% CV risk reduction with respect to those starting on monotherapy (95% CI: 5% to 16%). Compared with patients who maintained monotherapy also during follow-up, those who started on combination therapy and kept it along the entire period of observation had 26% reduction of CV risk (95% CI: 15% to 35%). In daily life practice, a combination of antihypertensive drugs is associated with a great reduction of CV risk. The indication for using combination of blood pressure drugs should be broadened. (Hypertension. 2011;58:566-572.)

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“…However, factors, such as ethnicity or socioeconomic status, can be confidently ruled out because the Lombardy population is largely white, and we have previously found that in Lombardy, income and educational differences play no role in the persistence on antihypertensive drug treatment. 33 Furthermore, it is unlikely that the increased risk of HF in patients with low adherence to antihypertensive drug treatment is accounted for a more compromised clinical status because (1) patients prescribed multiple antihypertensive drugs at the start were excluded to minimize participation in the study of individuals with a more severe hypertension and greater cardiovascular risk 14 , (2) data were adjusted for several demographic, therapeutic, and clinical characteristics, (3) although our database did not make BP values available, 32 adjustment included several proxies of the severity of hypertension and the difficulties of achieving therapeutic results, such as the number of antihypertensive drugs, the switching between antihypertensive drug classes, the number of prescribing physicians, and the addition to antihypertensive drug treatment of nonhypertensive cardiovascular agents, 34 and (4) patients with a more severe hypertension and a higher cardiovascular risk are known to have a better rather than a worse adherence to drug treatment. 35 Of course, this does not entirely eliminate the problem of confounding, one aspect of which is that because adherence may be a surrogate for overall health-seeking behavior, patients more adherent to antihypertensive drugs might also have more regularly followed healthy lifestyle advices, more effectively treated other cardiovascular risk factors, or dealt with HF more frequently as out-rather than in-hospital.…”

Section: Limitationsmentioning

confidence: 99%

Adherence With Antihypertensive Drug Therapy and the Risk of Heart Failure in Clinical Practice

et al. 2015

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Abstract-Randomized clinical trials have shown that antihypertensive treatment reduces the risk of heart failure (HF).Limited evidence exists, however, on whether and to what extent this benefit is translated into real-life practice. A nested case-control study was carried out by including the cohort of 76 017 patients from Lombardy (Italy), aged 40 to 80 years, who were newly treated with antihypertensive drugs during 2005. Cases were the 622 patients who experienced hospitalization for HF from initial prescription until 2012. Up to 5 controls were randomly selected for each case. Logistic regression was used to model the HF risk associated with adherence to antihypertensive drugs, which was measured by the proportion of days covered by treatment (PDC). Data were adjusted for several covariates. Sensitivity analyses were performed to account for possible sources of systematic uncertainty. Compared with patients with very low adherence (PDC, ≤25%), low, intermediate, and high adherences were associated with progressively lower risk of HF, reduction in the high-adherence group (>75%) being 34% (95% confidence interval, 17%-48%). Similar effects were observed in younger (40-70 years) and older (71-80 years) patients and between patients treated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. There was no evidence that adherence with calciumchannel blockers reduced the HF risk. Antihypertensive treatment lowers the HF risk in real-life practice, but adherence to treatment is necessary for a substantial benefit to take place. This is the case with a variety of antihypertensive drugs. Corrao et al Antihypertensive Agents and Heart Failure 743these, those who received at least 1 antihypertensive drug prescription during 2005 were identified, and the first dispensation was defined as the index prescription. Antihypertensive drugs included diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and calcium-channel blockers (CCBs) initially dispensed as monotherapy. Patients with an initial prescription of ≥2 antihypertensive drugs were excluded to reduce the range of hypertension severity, given that compared with monotherapy, need of multiple drug treatment reflects an increased risk of cardiovascular events, including HF. 14 Exclusion was extended to other patient categories, such as patients who (1) received at least 1 antihypertensive drug prescription within the 5 years before the index prescription, to limit inclusion to newly treated individuals; (2) had been hospitalized for cardiovascular disease or used drugs for coronary heart disease or HF, within the 5 years before the index prescription to limit data collection to the setting of primary cardiovascular prevention; (3) were beneficiaries of the National Health Service from <5 years before the start of prescription; and (4) did not reach at least 1 year of followup. Patients who had previously received ≥1 prescriptions of digitalis were also excluded because the use of digi...

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Do socioeconomic disparities affect accessing and keeping antihypertensive drug therapy? Evidence from an Italian population-based study

Cited by 26 publications

References 33 publications

Factors involved in the discontinuation of antihypertensive drug therapy

Factors involved in the discontinuation of antihypertensive drug therapy

Cardiovascular Protection by Initial and Subsequent Combination of Antihypertensive Drugs in Daily Life Practice

Adherence With Antihypertensive Drug Therapy and the Risk of Heart Failure in Clinical Practice

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