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Low adherence rates 'treble risk of stroke'

Patients who are not adherent to antihypertensive agents treble their risk of dying from a stroke, say researchers.

The study

Finnish researchers studied 73,527 hypertensive patients who were aged 30 years or older and without pre-existing stroke or cardiovascular disease for 12 years. Study outcomes were death or hospitalisation due to stroke. For each year of the study, year-by-year adherence was determined by the number of days covered by filled prescriptions for antihypertensive medication. Follow-ups occurred at two and 10 years after the start of continuous antihypertensive treatment. Adherence was determined as a period of 365 days during which the patient had three or more antihypertensive prescriptions filled; non-adherence if these requirements were not met.

The results

During the study 2,144 patients died from stroke and 24,560 were hospitalised due to stroke. At the two and 10-year follow-up, non-adherent patients had odds of 3.81 and 3.01 for stroke death, compared with adherent patients. The corresponding odds ratios (OR) for stroke hospitalisation was 2.74 at year two and 1.71 at year ten. The relationship between non-adherence and stroke followed a dose-response pattern: the lower the adherence, the greater the risk of death or hospitalisation due to stroke.

What this means for GPs

The researchers note that their results ‘emphasise the importance of hypertensive patients remaining adherent to antihypertensive therapy’ in order to ‘minimise such serious complications as fatal and non-fatal stroke events.’

Eur Heart J, online 17 July

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