Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients

Abstract

Objective: Evaluate the impact of antihypertensive drugs (AHD) on stroke and acute myocardial infarction (AMI) and death for 3 cohorts of patients: diabetics, high risk, and hypertensive. Methods: This was a retrospective cohort obervational study based on administrative database of 7 Italian Local Health Units. Newly treated patients with AHD were enrolled from 01/01/2004 to 06/30/2007. Drug utilization and incidence of death, stroke and AMI were measured until 12/31/2007. Results: The study enrolled 125,770 patients aged ≥ 18-year-old: 8516 diabetic, 8549 high risk, and 108,705 hypertensive. Diabetic and high risk patients were more frequently male (57.2%, 64.9% VS 46.6%) and older (66.4 ± 11.6, 67.5 ± 13.2 VS 61.6 ± 13.9) than hypertensive patients and were more treated with concomitant therapy. Drugs acting on the renin-angiotensin system were the more fre- quent choice in the three cohorts but with a dif- ferent prevalence (63.9%, 52.9%, 35.9% in dia- betic, hypertensive and high risk patients re- spectively). Adherent patients to AHD > 80% were 44.0% among diabetic patients, 48.4% among high risk, 35.2% among hypertensive. A Cox regression model showed that the risk of the combined outcome was determined by increasing age, male gender, presence of concomitant therapy, low adherence to AHD and first choice of AHD. Conclusions: An integrated analysis of prescription and hospital admission database has the great advantage that it uses routinely available data, it can be done quickly and by few staff, and it is less expensive than planned large scale survey.

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Esposti, L. , Saragoni, S. , Veronesi, C. , Cerra, C. , Batacchi, P. , Pagliaro, C. , Sturani, A. and Esposti, E. (2013) Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients. Health, 5, 1-8. doi: 10.4236/health.2013.54A001.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Ezzati, M., Lopez, A.D., Rodgers, A., et al. (2002) Selected major risk factors and global and regional burden of disease. Lancet, 360, 1347-1360. doi:10.1016/S0140-6736(02)11403-6
[2] Blood Pressure Lowering Treatment Trialists Collaboration (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: Results of prospectively-designed overviews of randomized trials. Lancet, 362, 1527-1535.
[3] Law, M.R., Morris, J.K. and Wald, N.J. (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. British Medical Journal, 338.
[4] Neal, B., MacMahon, S. and Chapman, N. (2000) Effects of ACE inhibitors, calcium antagonists, and other blood- pressure-lowering drugs: Results of prospectively designed overviews of randomised trials. Lancet, 356, 1955-1964. doi:10.1016/S0140-6736(00)03307-9
[5] The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) (2007) 2007 Guidelines for the management of arterial hypertension. European Heart Journal, 28, 1462-1536.
[6] Campbell, N.R.C., Khan, N.A., Hill, M.D., et al. (2009) On the behalf of the canadian hypertension education program. 2009 Canadian hypertension education program recommendations: The scientific summary—An annual update. Canadian Journal of Cardiology, 25, 271-277. doi:10.1016/S0828-282X(09)70490-8
[7] Degli Esposti, L. and Valpiani, G. (2004) Pharmaco-economic burden of undertreating hypertension. Pharmacoeconomics, 22, 907-928. doi:10.2165/00019053-200422140-00002
[8] Degli Esposti, L., Saragoni, S., Benemei, S., et al. (2011) Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients. Journal of ClinicoEconomics and Outcomes Research, 3, 47-54. doi:10.2147/CEOR.S15619
[9] Egan, B.M., Zhao, Y. and Axon, R.N. (2010) US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA, 303, 2043-2050. doi:10.1001/jama.2010.650
[10] Di Bari, M., Balzi, D., Roberts, A.T., et al. (2010) Prognostic stratification of folder persons based on simple administrative data: Development and validation of the “Silver Code”, to be used in emergency department triage. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 65, 159-164. doi:10.1093/gerona/glp043
[11] Ministero del Lavoro, della Salute e delle Politiche Sociali (2005) Rapporto annuale sulle attivita’ di ricovero ospedaliero. http://www.ministerosalute.it/programmazione/sdo/sezDocumenti.jsp?id=148&label=osp
[12] Rasmussen, J.N., Chong, A. and Alter, D.A. (2007) Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA, 297, 177-186. doi:10.1001/jama.297.2.177
[13] Suissa, S. (2007) Immortal time bias in observational studies of drug effects. Pharmacoepidemiology Drug Safety, 16, 241-249. doi:10.1002/pds.1357
[14] Clarke, K.W., Gray, D. and Hampton, J.R. (1994) Implication of prescriptions for nitrates: 7 year follow up of patients treated for angina in general practice. British Heart Journal, 71, 38-40. doi:10.1136/hrt.71.1.38
[15] Catalan, V.S. and LeLorier, J. (2000) Predictors of long- term persistence on stations in a subsidized clinical population. Value Health, 3, 417-426. doi:10.1046/j.1524-4733.2000.36006.x
[16] Kettani, F.Z., Dragomir, A., Cote, R., et al. (2009) Impact of better adherence to antihypertensive antihypertensive agents on cerebrovascular disease for primary prevention. Stroke, 40, 213-220. doi:10.1161/STROKEAHA.108.522193
[17] Black, N. (1996) Why we need observational studies to evaluate the effectiveness of health care. British Medical Journal, 312, 1215-1218. doi:10.1136/bmj.312.7040.1215
[18] Ho, P.M., Rumsfeld, J.S., Masoudi, F.A., et al. (2006) Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Archives of Internal Medicine, 166, 1836-1841. doi:10.1001/archinte.166.17.1836
[19] Rasmussen, J.N., Chong, A. and Alter, D.A. (2007) Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA, 297, 177-186. doi:10.1001/jama.297.2.177
[20] Gislason, G.H., Rasmessen, J.N., Abildstrom, S.Z., et al. (2007) Persistent use of evidence-based pharmacotherapy in heart failure is associated with improved outcomes. Circulation, 116, 737-744. doi:10.1161/CIRCULATIONAHA.106.669101
[21] Mazzaglia, G., Ambrosioni, E., Alacqua, M., et al. (2009) Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation, 120, 1598-1605. doi:10.1161/CIRCULATIONAHA.108.830299
[22] Sokol, M.C., McGuigan, K.A., Verbrugge, R.R., et al. (2005) Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care, 43, 521-530. doi:10.1097/01.mlr.0000163641.86870.af
[23] Leal, J., Luengo-Fernandez, Gray, A., et al. (2006) Economic burden of cardiovascular diseases in the enlarged European Union. European Heart Journal, 27, 1610- 1619. doi:10.1093/eurheartj/ehi733
[24] Law, M.R., Wald, N.J., Morris, J.K. and Jordan, R.E. (2003) Value of low dose combination treatment with blood pressure lowering drugs: Analysis of 354 randomised trials. British Medical Journal, 326, 1427-1431. doi:10.1136/bmj.326.7404.1427
[25] Degli Esposti, L., Degli Esposti, E., Valpiani, G., et al. (2002) A retrospective, population-based analysis of persistence with antihypertensive rug therapy in primary care practice in Italy. Clinical Therapeutics, 24, 1347-1357. doi:10.1016/S0149-2918(02)80039-X
[26] Degli Esposti, L., Di Martino, M., Saragoni, S., et al. (2004) Pharmacoeconomics of antihypertensive drug treatment: An analysis of how long patients remain on various antihypertensive therapies. The Journal of Clinical Hypertension, 6, 76-84. doi:10.1080/028418501127346846
[27] Hu, T. and Desai, J.P. (2004) Soft-tissue material properties under large deformation: Strain rate effect. Proceedings of the 26th Annual International Conference of the IEEE EMBS, San Francisco, 1-5 September 2004, 2758- 2761.
[28] Ortega, R., Loria, A. and Kelly, R. (1995) A semiglobally stable output feedback PI2D regulator for robot manipulators. IEEE Transactions on Automatic Control, 40, 1432-1436. doi:10.1109/9.402235
[29] Wit, E. and McClure, J. (2004) Statistics for microarrays: Design, analysis, and inference. 5th Edition, John Wiley & Sons Ltd., Chichester.
[30] Prasad, A.S. (1982) Clinical and biochemical spectrum of zinc deficiency in human subjects. In: Prasad, A.S., Ed., Clinical, Biochemical and Nutritional Aspects of Trace Elements, Alan R. Liss, Inc., New York, 5-15.
[31] Giambastiani, B.M.S. (2007) Evoluzione idrologica ed idrogeologica della pineta di San Vitale (Ravenna). Ph.D. Thesis, Bologna University, Bologna.
[32] Wu, J.K. (1994) Two problems of computer mechanics program system. Proceedings of Finite Element Analysis and CAD, Peking University Press, Beijing, 9-15.
[33] Honeycutt, L. (1998) Communication and design course. http://dcr.rpi.edu/commdesign/class1.html
[34] Wright, O. and Wright, W. (1906) Flying-machine. US Patent No. 821393.

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