From the Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea (J.K.).
Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (C.D.B.).
Hypertension. 2018 Aug;72(2):391-398. doi: 10.1161/HYPERTENSIONAHA.118.11139. Epub 2018 Jun 18.
Hypertension is the single most important risk factor for hemorrhagic stroke, a leading cause of mortality and disability worldwide. Adherence to antihypertensive medication is essential to achieving strict blood pressure control, but poor adherence is common in clinical practice. We evaluated adherence to antihypertensive medication in patients with acute hemorrhagic stroke and its effects on long-term outcome. This was a retrospective cohort study based on a nationwide health insurance claims database in South Korea. We included 1872 hypertensive patients who were admitted with acute hemorrhagic stroke during 2002 to 2013 (1354 cases of intracerebral hemorrhage and 518 cases of subarachnoid hemorrhage). Adherence to antihypertensive medication was calculated using the proportion of days covered by any antihypertensive medication throughout the follow-up period (categorized into poor <40%; intermediate 40%-80%; good >80%) and treated as a time-dependent variable. Primary outcome was defined as a composite of recurrent stroke (hemorrhagic or ischemic), myocardial infarction, or all-cause mortality. Time-dependent Cox proportional hazard regression analyses were performed. During the mean follow-up period of 4.45 years, 634 patients had the primary outcome. The proportion of patients with good adherence to antihypertensive medication was 46.8% at 1 year, 43.2% at 3 years, and 41.7% at 5 years of follow-up. Compared with good adherence, the adjusted hazard ratio (95% confidence interval) for the primary outcome was 1.80 (1.49-2.16) for poor adherence and 1.56 (1.27-1.93) for intermediate adherence.
高血压是导致出血性中风的最重要单一风险因素，出血性中风是全世界死亡和残疾的主要原因。坚持使用抗高血压药物对于实现严格的血压控制至关重要，但在临床实践中，坚持用药的情况并不常见。我们评估了急性出血性中风患者对降压药物的依从性及其对长期预后的影响。这是一项基于韩国全国健康保险索赔数据库的回顾性队列研究。我们纳入了 2002 年至 2013 年间因急性出血性中风住院的 1872 例高血压患者（1354 例脑出血和 518 例蛛网膜下腔出血）。通过在整个随访期间（分类为差<40％；中 40％-80％；好>80％）用任何抗高血压药物覆盖的天数比例来计算抗高血压药物的依从性，并将其作为时间依赖性变量。主要结局定义为复发性中风（出血性或缺血性）、心肌梗死或全因死亡率的复合事件。进行了时间依赖性 Cox 比例风险回归分析。在平均 4.45 年的随访期间，有 634 例患者出现主要结局。1 年时，4 年时和 5 年时，良好依从性的患者比例分别为 46.8％、43.2％和 41.7％。与良好依从性相比，不良和中等依从性的主要结局调整后的危险比（95％置信区间）分别为 1.80（1.49-2.16）和 1.56（1.27-1.93）。
