抗高血压药物治疗的依从性与高血压患者心血管疾病事件：队列研究中 2769700 名参与者的剂量-反应荟萃分析。

Adherence to antihypertensive medication and cardiovascular disease events in hypertensive patients: a dose-response meta-analysis of 2 769 700 participants in cohort study.

机构信息

From the Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan 450001, People's Republic of China.

Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong,1066 Academy Avenue, Shenzhen 440305, People's Republic of China.

出版信息

QJM. 2022 May 10;115(5):279-286. doi: 10.1093/qjmed/hcaa349.

DOI:10.1093/qjmed/hcaa349

PMID:33459791

Abstract

BACKGROUND

Recently, many studies have investigated the association between adherence to antihypertensive medication (AHM) and risk of cardiovascular disease (CVD) events for hypertensive patients; however, the results varied by different studies.

AIMS

The purpose of our meta-analysis was to explore the comprehensively summarized association between AHM adherence and risk of CVD events in hypertensive patients from cohort studies.

DESIGN

A dose-response meta-analysis.

METHODS AND RESULTS

We conducted a systematic search in two databases (PubMed and Embase) from 1974 to 15 December 2019 to identify English-language reports that assessed the association of AHM adherence with risk of CVD events in cohort studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association.

RESULTS

We included 16 cohort studies with 2 769 700 participants in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.56-0.78, I2 = 98.6%) for the highest versus lowest AHM adherence categories. We found a linear dose-response association of AHM adherence and CVD events (Pnonlinearity = 0.887), each 20% increase in AHM adherence was associated with a 13% reduced risk of CVD events (RR 0.87, 95% CI 0.83-0.92, I2 = 98.2%) in hypertensive patients.

CONCLUSION

High AHM adherence has a protective effect on CVD events for hypertensive patients, and improving medication adherence may provide long-term CVD benefits.

摘要

背景

最近，许多研究调查了高血压患者的抗高血压药物（AHM）依从性与心血管疾病（CVD）事件风险之间的关联；然而，不同研究的结果存在差异。

目的

我们的荟萃分析旨在探索队列研究中 AHM 依从性与高血压患者 CVD 事件风险之间的综合关联。

设计

剂量反应荟萃分析。

方法和结果

我们在两个数据库（PubMed 和 Embase）中进行了系统检索，检索时间为 1974 年至 2019 年 12 月 15 日，以确定评估队列研究中 AHM 依从性与 CVD 事件风险关联的英语报告。使用固定或随机效应模型估计汇总相对风险（RR）和 95%置信区间（CI）。使用限制性三次样条评估可能的线性或非线性关联。

结果

我们纳入了本荟萃分析中的 16 项队列研究，共有 2769700 名参与者。最高与最低 AHM 依从性类别相比，CVD 事件的汇总 RR 为 0.66（95%CI，0.56-0.78，I2=98.6%）。我们发现 AHM 依从性与 CVD 事件之间存在线性剂量反应关联（P非线性=0.887），AHM 依从性每增加 20%，CVD 事件的风险降低 13%（RR 0.87，95%CI 0.83-0.92，I2=98.2%）。