Department of Statistics, Unit of Biostatistics and Epidemiology, University of Milano-Bicocca, Italy.
J Hypertens. 2011 Mar;29(3):610-8. doi: 10.1097/HJH.0b013e328342ca97.
The effect of compliance with antihypertensive medications on the risk of cardiovascular outcomes in a population without a known history of cardiovascular disease has been addressed by a large population-based prospective, cohort study carried out by linking Italian administrative databases.
The cohort of 242 594 patients aged 18 years or older, residents in the Italian Lombardy Region, who were newly treated for hypertension during 2000-2001, was followed from index prescription until 2007. During this period patients who experienced a hospitalization for coronary or cerebrovascular disease were identified (outcome). Exposure to antihypertensive drugs from index prescription until the date of hospitalization or censoring was assessed. Proportional hazards models were fitted to assess the association between persistence on and adherence with antihypertensive drug therapy and outcome. Data were adjusted for several covariates.
During an average follow-up of 6 years, 12 016 members of the cohort experienced the outcome. Compared with patients who experienced at least one episode of treatment discontinuation, those who continued treatment had a 37% reduced risk of cardiovascular outcomes (95% confidence interval 34-40%). Compared with patients who had very low drug coverage (proportion of days covered ≤ 25%), those at intermediate (from 51 to 75%) and high coverage (>75%) had risk reductions of 20% (16-24%) and 25% (20-29%), respectively. Similar effects were observed when coronary and cerebrovascular events were considered separately.
In the real life setting, fulfillment compliance with antihypertensive medications is effective in the primary prevention of cardiovascular outcomes.
通过链接意大利行政数据库开展的一项大型基于人群的前瞻性队列研究，探讨了高血压患者遵医嘱用药对无已知心血管疾病史人群心血管结局风险的影响。
该队列纳入了 2000-2001 年新接受高血压治疗的、年龄在 18 岁及以上的 242594 例居住在意大利伦巴第地区的患者，随访自首次处方至 2007 年。在此期间，识别出因冠心病或脑血管病住院的患者（结局）。评估自首次处方至住院或删失日期的抗高血压药物暴露情况。采用比例风险模型评估抗高血压药物治疗的持续性和依从性与结局之间的关联。数据经多项协变量调整。
在平均 6 年的随访期间，队列中有 12016 例患者发生了结局事件。与至少发生一次停药事件的患者相比，持续治疗的患者心血管结局风险降低了 37%（95%置信区间 34-40%）。与药物覆盖率非常低（覆盖天数比例≤25%）的患者相比，药物覆盖率处于中间水平（51-75%）和高覆盖水平（>75%）的患者风险分别降低了 20%（16-24%）和 25%（20-29%）。分别考虑冠心病和脑血管事件时，也观察到了类似的效果。
在现实环境中，遵医嘱服用抗高血压药物可有效预防心血管结局。
