Prediction of Cardiovascular Events in Subjects in the Second Australian National Blood Pressure Study

Abstract

Abstract-Estimating absolute risk rather than measurement of blood pressure alone is considered the best way to identify those who would most likely benefit from medical intervention. Risk calculators used to estimate risk in those without previous cardiovascular disease (CVD) events are based on the Framingham Heart Study, which had no person Ͼ74 years of age at baseline. This needs to be addressed, because age is the most important determinant of risk. We estimated the predictive value of 3 risk equations for CVD end points in the Second Australian National Blood Pressure study cohort (mean age: 71.9 years at baseline). Observed and predicted 5-year incidence rates, 2 goodness-of-fit tests, and Harrell C statistic and area under the receiver operator characteristic curve were used to assess the ability of the equations to predict CVD outcomes over 5 years. A recalibration analysis was undertaken. Significant (PϽ0.05) 2 goodness-of-fit statistics were observed using each of the risk equations for myocardial infarction, coronary heart disease, stroke, or CVD morbidity or mortality across age groups and both sex. All of the overall C statistics or the area under the receiver operator characteristic curve indicated modest discrimination of the algorithms for prediction of the outcomes for coronary heart disease and CVD morbidity and mortality, myocardial infarction, or stroke (Framingham); cardiac death (Pocock); and CVD events (Dubbo). Recalibration analyses showed that it would be inappropriate to apply the risk equations to the Second Australian National Blood Pressure study population. New risk equations for CVD events in the hypertensive aged are needed. (Hypertension. 2010;56:44-48.)

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

“…This makes improvement of adherence with antihypertensive medicaments, a fundamental goal to pursue for protecting patients against HF. Our study also agrees with a post hoc analysis of an intervention trial performed in Australia 19 that better adherence to treatment is accompanied by HF protection in old hypertensive patients, a finding of obvious importance because in old individuals, HF plays a crucial role as a cause of death, hospitalization, and healthcare-related costs. 9,12 However, in the Australian study, better adherence to treatment was found to guarantee a lesser degree of protection in younger patients, whereas in our †Adherence was measured according to the proportion of days with antihypertensive drugs available with respect to the days of overall follow-up.…”

Comparison of hypertension management between cancer survivors and the general public

“…This may be the result of their better adherence and more frequent BP monitoring, both of which lead to better-controlled BP. 22,26 As selfreported BP status is generally reliable and correlated with actual measured data, 27 it can be assumed that hypertensive cancer survivors are usually in better control of their BP than are hypertensive patients without cancer.…”

“…Our previous study showed similar antihypertensive medication adherence between cancer survivors and the comparison group (84.0% vs. 85.6%) using the claim data set. 17 The agreement between selfreported adherence and refill adherence is reported to be only poor to fair, 9,22 and it has been suggested that these two methods reflect different dimensions of medication-taking behavior. 34 Other potential explanations would be increased awareness of non-cancer care among cancer survivors between the study period (2002 vs. 2009), 35,36 and insufficient adjustment of potential confounders, such as education, employment status and smoking, in the previous study.…”

“…22 It has been used widely in previous clinical studies regarding adherence, 10,[21][22][23][24] although there has been some criticism that it is not very sensitive 19 and there is an inconsistent report regarding the concordance with actual behaviors. 25 Frequent BP measurement at home may help to improve awareness and concordance, and thus has been shown to be effective in lowering BP.…”

Impact of the physician-patient relationship on the treatment outcomes of arterial hypertension

“…7 However, a subsequent report from the ANBP2 hypertension trial in elderly patients found that patients who forget to take their medication significantly more frequently experience a cardiovascular event or death. 8 Beside poor patient adherence to medications and lifestyle changes, other factors contribute to low rates of blood pressure control, including the lack of awareness about hypertension, physician's failure to adhere to published treatment guidelines, and limited access to medical care and financial barriers to obtain medications. 9 For instance, unique characteristics of the physician-patient relationship may result in improved blood pressure control, but few studies have analyzed actual dimensions of this issue that may impact blood pressure level or how improved physician-patient communication could have an impact upon hypertension treatment.…”