Faculties of Pharmacy and Medicine, University of Montreal, Montreal, Quebec, Canada.
Br J Clin Pharmacol. 2010 Jan;69(1):74-84. doi: 10.1111/j.1365-2125.2009.03547.x.
Antihypertensive (AH) agents have been shown to reduce the risk of cardiovascular events, including coronary artery disease (CAD). Previous surveys have shown that a substantial number of patients with diagnosed hypertension remain uncontrolled. Non-adherence to AH agents may reduce the effectiveness. The aim was to evaluate the impact of better adherence to AH agents on the occurrence of CAD in a real clinical setting.
A cohort of 83 267 patients was reconstructed using the Régie de l'assurance maladie du Québec databases. Patients were eligible if they were between 45 and 85 years of age without indication of cardiovascular disease, and had been newly treated with AH agents between 1999 and 2004. A nested case-control design was used to study the incidence of CAD. Every case of CAD was matched for age and duration of follow-up to up to 15 randomly selected controls. The adherence level was measured by calculating the medication possession ratio. Cases' adherence was calculated from the start of follow-up to the time of the CAD (index date). For controls, adherence was calculated from the start of follow-up to the time of selection (index date). Rate ratios of CAD were estimated by conditional logistic regression adjusting for covariables.
The mean patient age was 65 years, 37% were male, 8% had diabetes and 18% had dyslipidaemia. High adherence level (96%) to AH therapy compared with lower adherence level (59%) was associated with a relative risk reduction of CAD events (rate ratios 0.90; 0.84, 0.95). Risk factors for CAD were male gender, diabetes, dyslipidaemia and developing a cardiovascular condition disease during follow-up.
Our study suggests that better adherence to AH agents is associated with a risk reduction of CAD. Adherence to AH agents needs to be improved so that patients can benefit from the full protective effects of AH therapies.
已知信息：
不依从治疗可能是导致心血管疾病发病率和死亡率上升的重要原因之一。
但是，到目前为止，几乎没有大规模的有效性研究评估抗高血压药物的依从水平与心血管疾病一级预防的主要心血管结局之间的关系。
本研究新增信息：
研究结果表明，抗高血压药物的依从性与冠心病的相对风险降低之间存在关联。
需要提高抗高血压药物的依从性，使患者能够从抗高血压治疗的全部保护作用中受益。
目的：
抗高血压药物（AH）已被证明可降低心血管事件（包括冠心病）的风险。先前的调查显示，大量被诊断患有高血压的患者仍未得到控制。不依从 AH 药物治疗可能会降低治疗效果。本研究旨在评估在真实临床环境中，提高 AH 药物的依从性对冠心病发生的影响。
方法：
使用魁北克省医疗保险局数据库重建了 83267 名患者的队列。患者年龄在 45 至 85 岁之间，无心血管疾病指征，1999 年至 2004 年间新接受 AH 药物治疗，符合条件。采用巢式病例对照设计研究冠心病的发病率。每个冠心病病例均按年龄和随访时间与多达 15 名随机选择的对照进行匹配。通过计算药物占有比来衡量依从性水平。对病例的依从性从开始随访到冠心病（索引日期）的时间进行计算。对对照者而言，从开始随访到入选的时间（索引日期）计算依从性。通过条件逻辑回归调整协变量估计冠心病的风险比。
结果：
患者的平均年龄为 65 岁，37%为男性，8%患有糖尿病，18%患有血脂异常。与较低的依从水平（59%）相比，AH 治疗的高依从水平（96%）与冠心病事件的相对风险降低相关（风险比 0.90；0.84，0.95）。冠心病的危险因素包括男性、糖尿病、血脂异常和随访期间发生心血管疾病。
结论：
我们的研究表明，提高抗高血压药物的依从性与冠心病风险降低有关。需要提高抗高血压药物的依从性，使患者能够从抗高血压治疗的全部保护作用中受益。
