From the National Centre for Healthcare Research & Pharmacoepidemiology (F.R., A.C., L.M., G.C.), University of Milano-Bicocca Milan, Italy.
Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods (F.R., A.C., G.C.), University of Milano-Bicocca Milan, Italy.
Hypertension. 2020 Aug;76(2):442-449. doi: 10.1161/HYPERTENSIONAHA.120.14683. Epub 2020 Jun 8.
Aim of our study was to assess the relationship between adherence with antihypertensive drugs and the risk of death in frail versus nonfrail old individuals. Using the database of the Lombardy Region (Italy), we identified 1 283 602 residents aged ≥65 years (mean age 76) who had ≥3 prescriptions of antihypertensive drugs between 2011 and 2012. A nested case-control design was applied, with cases being the cohort members who died during the observation period (7 years). Logistic regression was used to model the association of interest, with adjustment for potential confounders. Adherence was measured by the proportion of the follow-up covered by prescriptions, and the analysis was separately performed in patients with a good, medium, poor, and very poor clinical status, as assessed by a score that has been shown to be a sensitive predictor of death in the Italian population. The 7-year death probability increased from 16% (good) to 64% (very poor) clinical status. Compared with patients with very low adherence with antihypertensive treatment (<25% of follow-up time covered by prescriptions), those with high adherence (>75% of time covered by prescriptions) exhibited a lower risk of all-cause mortality in each group, the difference decreasing progressively (-44%, -43%, -40%, and -33%) from the good to the very poor clinical status. Adherence with antihypertensive drug treatment was also associated with a lower risk of cardiovascular mortality. Adherence with antihypertensive appears to be protective in frail old patients, but the benefit is less marked than in patients with a good clinical status.
我们的研究目的是评估在虚弱和非虚弱的老年个体中，抗高血压药物的依从性与死亡风险之间的关系。我们利用意大利伦巴第地区（意大利）的数据库，确定了 1283602 名年龄≥65 岁（平均年龄 76 岁）的居民，他们在 2011 年至 2012 年间至少有 3 次抗高血压药物处方。采用巢式病例对照设计，病例为观察期间（7 年）死亡的队列成员。使用逻辑回归来建立感兴趣的关联模型，并对潜在的混杂因素进行调整。通过处方覆盖的随访比例来衡量依从性，在评估临床状况良好、中等、差和极差的患者中分别进行分析，这一评分已被证明是意大利人群死亡的敏感预测指标。7 年的死亡概率从临床状况良好（16%）增加到极差（64%）。与抗高血压治疗依从性极低（<25%的随访时间由处方覆盖）的患者相比，高依从性（>75%的时间由处方覆盖）的患者在每个组中全因死亡率的风险都较低，这种差异从临床状况良好逐渐降低（-44%、-43%、-40%和-33%）至极差。抗高血压药物治疗的依从性也与心血管死亡率降低相关。抗高血压药物的依从性似乎对虚弱的老年患者具有保护作用，但与临床状况良好的患者相比，获益程度较低。
