Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea.
Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea.
J Am Heart Assoc. 2023 Jul 18;12(14):e029362. doi: 10.1161/JAHA.123.029362. Epub 2023 Jul 8.
Background Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer. Methods and Results Using the 2002 to 2013 Korean National Health Insurance Service-National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio <0.8), and poor (medication possession ratio <0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow-up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85-fold and 2.19-fold increased risk for overall mortality, and 1.72-fold and 1.71-fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33-fold and 1.34-fold elevated risk of new-onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes. Conclusions Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.
高血压是发病率的一个重要原因，可使患者易患主要心血管事件和死亡。本研究旨在探讨成年癌症患者抗高血压药物治疗的依从性与临床结局之间的关系。
利用 2002 年至 2013 年韩国国家健康保险服务-国家样本队列，我们提取了接受抗高血压药物治疗的成年癌症患者。根据药物维持率值，参与者被分为 3 组：良好（药物维持率≥0.8）、中度（0.5≤药物维持率<0.8）和差（药物维持率<0.5）依从组。主要结局是全因和心血管死亡率。次要结局是因主要心血管疾病需要住院治疗的心血管事件。在 19246 例伴有高血压的癌症患者中，66.4%为不依从组（26.3%为中度和 40.0%为差）。在中位数为 8.4 年的随访期间，发生了 2752 例死亡和 6057 例心血管事件。与良好依从组相比，中度和差依从组的全因死亡率分别增加了 1.85 倍和 2.19 倍，心血管死亡率分别增加了 1.72 倍和 1.71 倍，在调整了可能的混杂因素后。此外，中度和差依从组新发心血管事件的风险分别增加了 1.33 倍和 1.34 倍。这些趋势在心血管事件亚型中是一致的。
癌症患者对抗高血压药物的依从性较差，与成年高血压癌症患者的临床结局较差有关。应更加关注提高癌症患者对抗高血压药物的依从性。
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