Discontinuation of anti-hypertensive drugs increases 11-year cardiovascular mortality risk in community-dwelling elderly (the Bambuí Cohort Study of Ageing).

Maria Lea Correa Leite,Maria Fernanda Lima-Costa,Joselia O A Firmo,Antonio Ignacio Loyola Filho

doi:10.1186/1471-2458-14-725

Abstract

BackgroundHypertension remains a major public health problem whose management is hampered by poor persistence with pharmacological therapy. The aim of this study was to evaluate the association between discontinuing antihypertensive drugs (AHDs) and the risk of cardiovascular mortality in the elderly.MethodsA population-based prospective cohort study of all of the ≥60-year-old residents in Bambuí city (Brazil) enrolled 1606 subjects (92.2%), of whom 1494 (93.0%) were included in this study. The use of AHDs was ascertained annually in a real-clinical context, and time-varying AHD exposure was categorised as non-use, current use or stopped. The predicted cardiovascular mortality rates were estimated using interval Poisson models for ungrouped person-time data, taking into account current levels of systolic blood pressure (BP).ResultsThe overall adjusted cardiovascular mortality risk ratio of AHD stoppers vs current users was 3.12 (95% CI: 2.35-4.15). There was a significant interaction with BP levels: the association between discontinuing AHDs and the risk of cardiovascular mortality was stronger at higher systolic BP levels. The estimates of the risk of cardiovascular mortality over the follow-up period were similar in AHD users and non-users, for whom AHDs were never prescribed.ConclusionDiscontinuing AHDs increases the risk of cardiovascular mortality in the elderly. Misconceptions about symptoms or drug-related adverse effects could underlie a subject’s decision to discontinue AHDs. Greater attention should be paid to the choice of AHDs and informative action.

Highlights

Hypertension remains a major public health problem whose management is hampered by poor persistence with pharmacological therapy
The overall adjusted rate ratios (RRs) of CV mortality estimated for the antihypertensive drugs (AHDs) stoppers was 3.12
The mortality rates (MRs) were generally lower in the AHD non-users group compared with the current users

Summary

Introduction

Hypertension remains a major public health problem whose management is hampered by poor persistence with pharmacological therapy. There is growing evidence that antihypertensive treatment is beneficial in the elderly [1], but hypertension remains a major public health problem whose prevalence is increasing throughout the world with the ageing of the population [2]. There are a number of published studies concerning the predictors of persistence [13,14], and some data concerning the health and economic consequences of non-adherence [15,16] but, to the best of our knowledge, no attempt has yet been made to quantify the impact of discontinuing antihypertensive drugs (AHDs) on the risk of cardiovascular (CV) mortality in the elderly. People have consistently resorted to this program to obtain essential medicines that they have been unable to access in the public sector [20]

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