PS1-06: The Impact of Treatment Intensification and Medication Adherence in Achieving Blood Pressure Control Among Coronary Artery Disease Patients

Abstract

Background and Aims: Among coronary artery disease (CAD) patients, control of hypertension reduces rates of myocardial infarction and mortality. Yet, BP control among CAD patients remains sub-optimal in clinical practice. Few prior studies have had the longitudinal data necessary to assess the role of treatment intensification and medication adherence in achieving optimal control. Methods: In this retrospective cohort study, we evaluated baseline and 1-year BP control rates among 15,102 HTN patients with an incident diagnosis of CAD between January 1, 2003 and December 31, 2006. Among those patients with sub-optimal baseline BP control, we assessed the contribution of treatment intensification and medication adherence to achieving 1-year BP control. Sub-optimal BP control was defined as systolic BP =140 mmHg and/or diastolic BP =90 mmHg (for those with diabetes or renal disease, sub-optimal control was defined as SBP =130mmHg and/or DBP =80mmHg). Treatment intensification was defined as an increase in BP medication dosage, the addition of another BP medication, and/or a switch of medication that resulted in a higher bioequivalent dose. Medication adherence was calculated using the proportion of days covered by medication prescription, and defined as a PDC > 80%. Logistic regression was used to determine the contribution of treatment intensification and medication adherence on achieving 1-year BP control, adjusting for baseline patient variables. Results: At the time of CAD diagnosis, 9,513 (65%) had suboptimal BP control. At 1 year, 3,628(38%) of these subjects achieved BP control. Treatment intensification occurred more often among those patients who achieved 1-year BP control than those who did not (54% vs. 42%, p-value <0.0001). Medication adherence was similar between patients who achieved 1-year BP control and those who did not (87% vs. 86%, p-value 0.10) during the year post-CAD. In adjusted analyses, treatment intensification was significantly associated with 1 year BP control (OR 1.42 95% CI 1.39, 1.45). In contrast, medication adherence was not significantly associated with 1 year BP control (OR 1.02, 95% CI 0.87, 1.16). Conclusions: Treatment intensification, but not medication adherence, was significantly associated with 1-year BP control among a newly diagnosed CAD population. Interventions to improve treatment intensification may improve BP control and patient outcomes.