Dalli Lachlan L, Olaiya Muideen T, Kim Joosup, Andrew Nadine E, Cadilhac Dominique A, Ung David, Lindley Richard I, Sanfilippo Frank M, Thrift Amanda G, Nelson Mark R, Gall Seana L, Kilkenny Monique F
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.).
Hypertension. 2023 Jan;80(1):182-191. doi: 10.1161/HYPERTENSIONAHA.122.19883. Epub 2022 Nov 4.
Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke.
A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012-2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights.
Among 4076 eligible participants (median age 68 years; 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54-0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62-0.98) than those with a proportion of days covered <80%.
High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.
关于降压药物在不增加跌倒风险的情况下是否有助于预防卒中后重大不良心血管事件（MACE），真实世界证据有限。我们调查了卒中后降压药物依从性与MACE发生率及需要住院治疗的跌倒之间的关联。
对急性卒中后新开具降压药物的成年人进行一项回顾性队列研究（澳大利亚卒中临床注册研究2012 - 2016年；昆士兰州和维多利亚州）。根据卒中后前6个月的覆盖天数比例，利用药品配药记录确定药物依从性。出院后6至18个月的结局包括：（i）MACE，全因死亡、复发性卒中和急性冠状动脉综合征的复合结局；以及（ii）需要住院治疗的跌倒。使用Cox模型进行估计，并使用逆概率处理权重对30多个混杂因素进行校正。
在4076名符合条件的参与者中（中位年龄68岁；37%为女性），55%在出院后6个月内的覆盖天数比例≥80%。在随后的12个月中，360名（9%）参与者发生了MACE，337名（8%）经历了需要住院治疗的跌倒。在两组之间达到平衡后，覆盖天数比例≥80%的参与者发生MACE的风险降低（风险比：0.68；95%置信区间：0.54 - 0.84），与覆盖天数比例<80%的参与者相比，需要住院治疗的跌倒风险也降低（亚分布风险比：0.78；95%置信区间：0.62 - 0.98）。
卒中后6个月内高度依从降压药物与降低MACE风险和需要住院治疗的跌倒风险相关。应鼓励患者坚持服用降压药物，以优化卒中后的结局。
