Bailey James E, Wan Jim Y, Tang Jun, Ghani Muhammad A, Cushman William C
Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman D222, Memphis, TN 38163, USA.
J Gen Intern Med. 2010 Jun;25(6):495-503. doi: 10.1007/s11606-009-1240-1. Epub 2010 Feb 18.
This study seeks to determine whether antihypertensive medication refill adherence, ambulatory visits, and type of antihypertensive medication exposures are associated with decreased stroke and death for community-dwelling hypertensive patients.
This retrospective cohort study included all chronic medication-treated hypertensives enrolled in Tennessee's Medicaid program (TennCare) for 3-7 years during the period 1994-2000 (n = 49,479). Health care utilization patterns were evaluated using administrative data linked to vital records during a 2-year run-in period and 1- to 5-year follow-up period. Antihypertensive medication refill adherence was calculated using pharmacy records.
Associations with stroke and death were assessed using Cox proportional hazards modeling. Stroke occurred in 619 patients (1.25%) and death in 2,051 (4.15%). Baseline antihypertensive medication refill adherence was associated with decreased multivariate hazards of stroke [hazard ratio (HR) 0.91; 95% confidence interval (CI), 0.86-0.97 for 15% increase in adherence]. Adherence in the follow-up period was associated with decreased hazards of stroke (HR 0.92; CI 0.87-0.96) and death (HR 0.93; CI 0.90-0.96). Baseline ambulatory visits were associated with decreased death (HR 0.99; CI 0.98-1.00). Four major classes of antihypertensive agents were associated with mortality reduction. Only thiazide-type diuretic use was associated with decreased stroke (HR 0.89; CI 0.85-0.93).
Ambulatory visits and antihypertensive medication exposures are associated with reduced mortality. Increasing adherence by one pill per week for a once-a-day regimen reduces the hazard of stroke by 8-9% and death by 7%.
本研究旨在确定社区高血压患者的降压药物续方依从性、门诊就诊情况以及降压药物暴露类型是否与中风和死亡风险降低相关。
这项回顾性队列研究纳入了1994年至2000年期间参加田纳西州医疗补助计划（TennCare）3至7年的所有接受慢性药物治疗的高血压患者（n = 49,479）。在为期2年的导入期和1至5年的随访期内，利用与生命记录相关联的行政数据评估医疗保健利用模式。使用药房记录计算降压药物续方依从性。
采用Cox比例风险模型评估与中风和死亡的关联。619名患者发生中风（1.25%），2,051名患者死亡（4.15%）。基线降压药物续方依从性与中风的多变量风险降低相关[风险比（HR）0.91；依从性增加15%时，95%置信区间（CI）为0.86 - 0.97]。随访期的依从性与中风风险降低（HR 0.92；CI 0.87 - 0.96）和死亡风险降低（HR 0.93；CI 0.90 - 0.96）相关。基线门诊就诊与死亡风险降低相关（HR 0.99；CI 0.98 - 1.00）。四类主要降压药物与死亡率降低相关。仅噻嗪类利尿剂的使用与中风风险降低相关（HR 0.89；CI 0.85 - 0.93）。
门诊就诊和降压药物暴露与死亡率降低相关。对于每日一次的治疗方案，每周增加一片药的依从性可使中风风险降低8 - 9%，死亡风险降低7%。
