Scholarlink

<p>Background. Non-adherence to antihypertensive regimens undermines both hypertension therapy and the validity of clinical trials. However, existing adherence measures do not effectively reflect bidirectional medication-taking behavior. This secondary SPRINT analysis investigated at how dynamic, bidirectional adherence to medication patterns associated with cardiovascular outcomes. Methods. We analyzed self-reported medication information for 9343 participants. Adherence was divided into four categorized based on discrepancies between prescribed and taken medication over the first 12 months: full adherence, over-adherence, under-adherence, and fluctuating adherence. The primary outcomes were composite cardiovascular events and all-cause mortality; the secondary outcomes were 12-month systolic blood pressure (SBP) control, SBP variability from visit to visit (coefficient of variance), and serious adverse events (SAEs). Results. Over a median follow-up of 3.26 years, 53.6% displayed full adherence, while 16.2%, 22.7%, and 7.5% showed over-, under-, and fluctuating adherence. Compared to full adherence, fluctuating adherence was independently associated with significantly elevated risks of composite cardiovascular events (HR: 1.737, 95% CI: 1.250–2.414, <i>P</i>﹤0.001) and all-cause mortality (HR: 1.487, 95% CI: 1.030–2.147, <i>P</i> = 0.029). This pattern was also associated with decreased SBP control (OR: 0.825, 95% CI: 0.700–0.972, <i>P</i> = 0.022), increased SBP variability, and the highest incidence of SAEs in non-adherence groups. There were no significant changes in outcomes between over- or under-adherence and full adherence. Importantly, the detrimental association for fluctuating adherence persisted among a subgroup of patients classified as “fully adherent” by the self-reported Visual Analog Scale. Conclusions. Fluctuating antihypertensive adherence, characterized by unstable use of medications, was independently linked with poor SBP control increased cardiovascular risk and mortality. Hypertension studies and clinical practice ought to prioritize identifying and managing dynamic adherence patterns to enhance trial validity and optimize the therapeutic benefits. Registration ClinicalTrials.gov (NCT01206062).</p><p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Fluctuations in adherence to antihypertensive medication and cardiovascular outcomes: a secondary analysis of the SPRINT trial

  • 期刊论文

  • 发表日期：

    2026年1月15日

查看全文
  • Yue Wang,
  • Shaowen Tang,
  • Mingfang Li,
  • Minglong Chen

摘要

Background. Non-adherence to antihypertensive regimens undermines both hypertension therapy and the validity of clinical trials. However, existing adherence measures do not effectively reflect bidirectional medication-taking behavior. This secondary SPRINT analysis investigated at how dynamic, bidirectional adherence to medication patterns associated with cardiovascular outcomes. Methods. We analyzed self-reported medication information for 9343 participants. Adherence was divided into four categorized based on discrepancies between prescribed and taken medication over the first 12 months: full adherence, over-adherence, under-adherence, and fluctuating adherence. The primary outcomes were composite cardiovascular events and all-cause mortality; the secondary outcomes were 12-month systolic blood pressure (SBP) control, SBP variability from visit to visit (coefficient of variance), and serious adverse events (SAEs). Results. Over a median follow-up of 3.26 years, 53.6% displayed full adherence, while 16.2%, 22.7%, and 7.5% showed over-, under-, and fluctuating adherence. Compared to full adherence, fluctuating adherence was independently associated with significantly elevated risks of composite cardiovascular events (HR: 1.737, 95% CI: 1.250–2.414, P﹤0.001) and all-cause mortality (HR: 1.487, 95% CI: 1.030–2.147, P = 0.029). This pattern was also associated with decreased SBP control (OR: 0.825, 95% CI: 0.700–0.972, P = 0.022), increased SBP variability, and the highest incidence of SAEs in non-adherence groups. There were no significant changes in outcomes between over- or under-adherence and full adherence. Importantly, the detrimental association for fluctuating adherence persisted among a subgroup of patients classified as “fully adherent” by the self-reported Visual Analog Scale. Conclusions. Fluctuating antihypertensive adherence, characterized by unstable use of medications, was independently linked with poor SBP control increased cardiovascular risk and mortality. Hypertension studies and clinical practice ought to prioritize identifying and managing dynamic adherence patterns to enhance trial validity and optimize the therapeutic benefits. Registration ClinicalTrials.gov (NCT01206062).