Antihypertensive Users Research Articles

Prescription of renin–angiotensin system blockers and risk of acute kidney injury: a population-based cohort study

ObjectiveTo investigate whether there is an association between use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB) and risk of acute kidney injury (AKI).Study designWe conducted a new-user cohort...

Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemia among breast cancer survivors

Comorbidity among breast cancer survivors is prevalent, and adherence to medication management of comorbidities may be important for both chronic disease and cancer-related outcomes. Our objective was to determine characteristics associated with nonadherence to common chronic medications among breast cancer survivors. We conducted a retrospective cohort study of 4216 women in an integrated care system diagnosed with early-stage breast cancer between 1990 and 2008 and alive without recurrence or second primary breast cancer in the second-year following diagnosis. Adherence to antihypertensives, oral diabetes medications, and statins was measured during the second-year post-breast cancer diagnosis using medication possession ratios (MPR). Nonadherence was defined as MPR<0.80. We estimated odds ratios (OR) and 95% confidence intervals (CI) for nonadherence to antihypertensives, oral diabetes medications, and statins by various characteristics using multivariable logistic regression. Among 2308 users of antihypertensives (n=1779), diabetes medications (n=499) and/or statins (n=1072), 37% were nonadherent to antihypertensives; 75% were nonadherent to diabetes medications; 39% were nonadherent to statins. In adjusted models, younger age was associated with nonadherence to all three therapeutic classes. Certain cancer treatments were associated with nonadherence to antihypertensives (radiation: OR 1.21, 95% CI 1.01-1.47; endocrine therapy: OR 1.27, 95% CI 1.03-1.52) and diabetes medications (chemotherapy: OR 1.69, 95% CI 1.17-2.21). Less frequent primary care provider visits were associated with higher odds of nonadherence to antihypertensives (OR 1.70, 95% CI 1.19-2.22); and trends showed higher Charlson comorbidity scores associated with greater adherence to diabetes medications (P<0.001) and statins (P=0.032). Nonadherence to medications is high among breast cancer survivors, particularly diabetes medications, and is associated with cancer treatments and other patient characteristics. Additional research is warranted to understand the needs of cancer patients taking chronic medications and explore patient and provider factors influencing adherence.

The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change

Copayments for prescriptions may increase morbidity and mortality via reductions in adherence to medications. Relevant data can inform policy to minimise such unintended effects. We explored the generalisability of evidence for copayments by comparing two international copayment polices, one in Massachusetts and one in Ireland, to assess whether effects on medication adherence were comparable. We used national prescription data for public health insurance programmes in Ireland and Medicaid data in the U.S. New users of oral anti-hypertensive, anti-hyperlipidaemic and diabetic drugs were included (total n=14,259 in U.S. and n=43,843 in Ireland). We examined changes in adherence in intervention and comparator groups in each setting using segmented linear regression with generalised estimating equations.In Massachusetts, a gradual decrease in adherence to anti-hypertensive medications of −1% per month following the policy occurred. In contrast, the response in Ireland was confined to a −2.9% decrease in adherence immediately following the policy, with no further decrease over the 8 month follow-up. Reductions in adherence to oral diabetes drugs were larger in the U.S. group in comparison to the Irish group. No difference in adherence changes between the two settings for anti-hyperlipidaemic drugs occurred.Evidence on cost-sharing for prescription medicines is not ‘one size fits all’. Time since policy implementation and structural differences between health systems may influence the differential impact of copayment policies in international settings.

PS 06-02 Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Bangladeshi adults

Objective: Bangladesh is facing an epidemiological transition with a growing burden of non-communicable diseases. Traditionally hypertension and associated complications in women receive less recognition and there is a dearth of related publications. The study aims to explore gender differences in high blood pressure awareness and antihypertensive use in Bangladeshi adults at the community level. Another objective is to identify factors associated with uncontrolled hypertension among antihypertensive users. Design and Method: Data from the most recent Bangladesh Demographic and Health Survey (BDHS 2011) was analysed. From a nationally representative sample of 3,871 males and 3,960 females, aged ≥ 35 years, blood pressure and related information were collected following WHO guidelines. Logistic regression models were used to estimate adjusted odds ratio (AOR) for factors affecting blood pressure awareness, antihypertensive use and uncontrolled hypertension among those taking antihypertensive, separately for males and females. All analyses were weighted considering sampling design. Results: Women were more likely to have their blood pressure measured (76% vs. males 71%, p Conclusions: Blood pressure check-up and hypertension awareness were higher among women but did not translate into better antihypertensive medication practice compared to men. Gender disadvantage and inequity observed in antihypertensive use. Policy makers should explore uncontrolled hypertension burden, gender gap and geographical variations in the country.

Dementia risk with antihypertensive use and blood pressure variability: A cohort study.

To determine the association between discrete antihypertensive drug classes and incident dementia controlling for blood pressure variability (BPV) in the preceding 4 years. A total of 6,537 participants (mean age 79 years, 62% women) in a prospective population-based cohort were followed up for incident dementia. A 4-year time lag period was created to classify drug exposure and measure blood pressure. BPV (percent coefficient of variation [CV]) was regressed against 9 antihypertensive drug classes (BPVreg). Cox regression models were employed to determine hazard ratios (HRs) for incident dementia thereafter according to drug class, adjusted for mean blood pressure, covariates, and BPV or BPVreg. Over a median 8.4 years follow-up (interquartile range 6.7-9.0), lower dementia risk was associated with nondihydropyridine calcium channel blocker (HR 0.56; 95% confidence interval [CI] 0.31-1.00, p = 0.05) and loop diuretics (HR 0.45; 95% CI 0.22-0.93, p = 0.03) after adjusting for CV-BPV. Similar findings were obtained in analyses restricted to antihypertensive drug users for nondihydropyridine calcium channel blocker (HR 0.52; 95% CI 0.28-0.95, p = 0.03) and loop diuretics (HR 0.40; 95% CI 0.19-0.83, p = 0.01). All systolic BPV × antihypertensive drug interaction terms were not different from p < 0.05. Nondihydropyridine calcium channel blocker and loop diuretics were associated with a reduced dementia risk independent of CV-BPV in the preceding 4 years. Systolic BPV was not the primary mechanism through which antihypertensive drug classes lower dementia risk.

Antihypertensive Medications and the Survival Rate of Osseointegrated Dental Implants: A Cohort Study.

Antihypertensive drugs in general are beneficial for bone formation and remodeling, and are associated with lower risk of bone fractures. As osseointegration is influenced by bone metabolism, this study aimed to investigate the association between antihypertensive drugs and the survival rate of osseointegrated implants. This retrospective cohort study included a total of 1,499 dental implants in 728 patients (327 implants in 142 antihypertensive-drugs-users and 1,172 in 586 nonusers). Multilevel mixed effects parametric survival analyses were used to test the association between antihypertensive drugs use and implant failure adjusting for potential confounders. Only 0.6% of the implants failed in patients using antihypertensive drugs while 4.1% failed in nonusers. A higher survival rate of dental implants was observed among users of antihypertensive drugs [HR (95% CI): 0.12 (0.03-0.49)] compared to nonusers. Our findings suggest that treatment with antihypertensive drugs may be associated with an increased survival rate of osseointegrated implants. To our knowledge, this could be the first study showing that the systemic use of a medication could be associated with higher survival rate of dental implants.

Evaluation of medication adherence patterns amongst anti-hypertensive drug users in a tertiary care hospital in north India

Background: Non-adherence to prescribed medications is a major barrier in management of chronic diseases like hypertension, which can lead to treatment failure and can increase morbidity, mortality and health care costs. The objective of this study was to assess the level of adherence of hypertensive patients to their anti-hypertensive medications and various factors influencing the adherence among these patients. Methods: A cross sectional, observational, questionnaire based study was carried out amongst 70 patients diagnosed with hypertension. Adherence was measured using Morisky medication adherence score questionnaire (MMAS-8). Co-relation of various factors like age, sex, education level, number of drugs taken, presence of concomitant diseases etc. were assessed. Univariate and multivariate analysis was done to determine the factors associated with adherence. Results: The mean age of 70 patients (35 male, 35 female) were 52.29±11.39 years. Using MMAS-8, high, medium and low adherence was seen in 58.6%, 20.0% and 21.4% patients respectively. Middle age group patients were more adherent (60.8%) than younger age group and elderly (37.5%) (p-value &lt;0.05). Adherence rates were comparable in men and women. There was a positive correlation of adherence with education level, knowledge of BP goals and presence of diabetes. It showed negative correlation with chronicity of hypertension and number of drugs taken. Conclusions: Medication adherence rate was found to be low in the present study. The level of adherence to treatment among the participants can be achieved through better health promotion and education strategies.

Antihypertensive Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study.

Despite wide-spread use of antihypertensives in older adults, the literature is unclear about their association with incident recurrent falls over time. Health, Aging and Body Composition study participants (n = 2,948) who were well functioning at baseline (1997) were followed to Year 7 (2004). The main outcome was recurrent falls (≥2) in the ensuing 12 months. Antihypertensive use was examined as: (a) any versus none, (b) long- versus short-term (≥2 vs <2 years), and by (c) summated standardized daily dose (SDD; 1 = maximum recommended daily dose for one antihypertensive), and (d) subclass. Controlling for potential demographic, health status/behavior and access to care confounders, we found no increase in risk of recurrent falls in antihypertensive users compared to nonusers (adjusted odds ratio [AOR] = 1.13; 95% CI = 0.88-1.46), or those taking higher SDDs or for longer durations. Only those using a loop diuretic were found to have a modest increased risk of recurrent falls (AOR = 1.50; 95% CI = 1.11-2.03). Antihypertensive use overall was not statistically significantly associated with recurrent falls after adjusting for important confounders. Loop diuretic use may be associated with recurrent falls and needs further study.

Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

Abstract PD4-6: Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemias among breast cancer survivors

Abstract Background: Comorbidity among breast cancer (BC) survivors increases risk of overall mortality and recent reports have described some comorbid conditions to possibly influence risk of second BC events and BC-specific mortality. Therefore, clinical management of chronic conditions such as hypertension (HTN), diabetes mellitus (DM) and dyslipidemias in BC survivors may be important to both cancer- and non-cancer-related outcomes. Medication adherence for chronic conditions such as diabetes is poor in general populations and quality of care may be further impacted by BC diagnosis/treatment. The objective of this study was to describe characteristics associated with nonadherence to medications to treat HTN, DM and dyslipidemias among BC survivors enrolled in a large, integrated health plan. Methods: Retrospective cohort of 4,216 BC survivors, the Commonly Used Medications and Breast Cancer Outcomes (COMBO) study at Group Health Cooperative. Women in our analysis were diagnosed with stages I-II BC between 1990-2008 and alive and without recurrence or second primary BC in the year 365 days post-BC diagnosis (days 366-730). Medication users were identified by ≥1 dispensings of antihypertensives, oral DM medications, and/or statins. Data on incident BC, patient characteristics, and medications was obtained via linkage to the western Washington SEER registry, medical record and automated health plan data including pharmacy dispensing records. Medication adherence was measured using medication possession ratio (MPR) and classified as non-adherent if MPR&amp;lt;0.80. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for nonadherence vs adherence to antihypertensives, oral DM medications and statins by various characteristics using multivariate logistic regression. Results: We identified 1,929 prevalent users of antihypertensives (n=1,779), DM medications (n=499) and/or statins (n=1,072). 37% were non-adherent to antihypertensives; 75% were non-adherent to DM medications; 39% were non-adherent to statins. In adjusted models, younger women (ages &amp;lt;50, 50-64) were more likely to be non-adherent to all 3 therapeutic classes compared to older women (ages ≥65). Women who received radiation therapy (OR=1.21 95% CI 1.00-1.47) or endocrine therapy (OR=1.25 95% CI 1.03-1.52) were more likely to be non-adherent to antihypertensives; women treated with chemotherapy (OR=1.67 95% CI 1.03-2.69) were more likely to be non-adherent to DM medications. Greater BMI (P=0.001) and more frequent primary care provider visits (≥2 vs 0-1 only; OR=0.30 95% CI 0.24-0.38) were associated with better adherence to antihypertensives. Likewise, higher Charlson comorbidity scores (≥2 vs &amp;lt;2) were associated with greater adherence to DM medications (OR=0.49 95% CI 0.23-0.83) and statins (OR=0.54 95% CI 0.28-1.02). Conclusion: In this population-based cohort of BC survivors, nonadherence to medications for HTN, DM, and dyslipidemias was associated with younger age, and impact of specific BC treatments on medication adherence varied by therapeutic indication. Additional research is warranted to target patients in need of medication management as well as to explore patient preferences and provider factors that may influence medication adherence. Citation Format: Gregory S Calip, Denise M Boudreau. Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemias among breast cancer survivors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD4-6.

Use of antihypertensive drugs and risk of skin cancer.

Several antihypertensive drugs are photosensitizing and may therefore act as cocarcinogens with ultraviolet radiation. To examine whether antihypertensive drug use is associated with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM). We used population-based databases to conduct a case-control study including all first-time cases of SCC (n = 2282), BCC (n = 17,242), and MM (n = 3660) in northern Denmark, 1991-2010. We matched approximately 10 controls (n = 231,743) to each case by age, sex and county using risk-set sampling. We used conditional logistic regression to compute odds ratios (ORs) for skin cancer with 95% confidence intervals comparing ever users of antihypertensives (>2 previous prescriptions) with non-users (≤2 previous prescriptions). We adjusted for comorbidity and comedications. We further analysed use by duration (short term: <5 years; long term: ≥5 years) and intensity (low intensity or high intensity: <50% or ≥50% prescription coverage during total duration of use, respectively). Ever users of diuretics were at increased risk of SCC (OR 1.19; 1.06-1.33), driven by potassium-sparing agents alone (OR 1.40; 1.09-1.80) or with low-ceiling diuretics (OR 2.68; 2.24-3.21) and by long-term use (OR 1.41; 1.16-1.72 at low intensity; OR 1.44; 0.98-2.14 at high intensity). Ever users of sulphonamides (OR 1.49; 1.04-2.12) and non-aldosterone antagonist potassium-sparing agents (OR 2.26; 0.85-6.01) were at increased MM risk. The latter was also associated with BCC (OR 1.47; 1.00-2.17), as was low-ceiling diuretics combined with potassium-sparing agents (OR 1.23; 1.12-1.35). Long-term, low-intensity (OR 1.53; 1.05-2.23) and high-intensity (OR 1.44; 0.56-3.69) angiotensin receptor blocker use was associated with MM. Estimates for angiotensin-converting enzyme inhibitors, β-blockers, and calcium channel blockers were inconsistent or weak (<20% increased). Long-term angiotensin receptor blocker use was associated with risk of MM. Moreover, long-term diuretic use was associated with SCC risk, driven by potassium-sparing agents alone or in combination with low-ceiling diuretics.

A Prescription at Discharge Improves Long-term Adherence for Secondary Stroke Prevention

Medication adherence is important for optimal secondary stroke prevention. We evaluated short-term adherence to antihypertensive and lipid-lowering agents after a new ischemic stroke, as predictor of adherence at 1 and 2 years. A 5-year cohort of patients from 11 institutions in the Registry of the Canadian Stroke Network was linked to population-based administrative health records. Patients diagnosed with acute ischemic stroke and discharged home were included. Medication adherence was assessed through documented prescription filling at 7 days, 1 year, and 2 years. From 2003 to 2008, 6437 ischemic stroke patients were discharged home from hospital, and 1126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of discharge. Patients provided with a prescription at discharge were more likely to show adherence at 7 days. Adherence at 1 year remains higher in these patients for antihypertensive (93.8% vs. 87.7%; odds ratio [OR], 2.31; 95% confidence interval [CI], 1.69-3.16), lipid-lowering agents (88% vs. 81.6%; OR, 1.77; 95% CI, 1.36-2.32), or both (85.8% vs. 79.9%; OR, 1.72; 95% CI, 1.32-2.25). Findings are similar at 2 years for antihypertensive (92.2% vs. 87.7%; OR, 1.78; 95% CI, 1.3-2.43), lipid-lowering agents (82.6% vs. 79.0%; OR, 1.31; 95% CI, 1.01-1.69), or both (81.1% vs. 77.0%; OR, 1.4; 95% CI, 1.09-1.82). Provision of a prescription strengthens adherence at 1 week from discharge for both prior and new users of antihypertensive and lipid-lowering drugs. Medication adherence at 1 week after discharge for acute ischemic stroke predicts adherence for secondary preventive therapies at 1 and 2 years.

Factors involved in the discontinuation of antihypertensive drug therapy: an analysis from real life data.

We have previously shown that in Italian region of Lombardy (about 10 million citizens), adherence to antihypertensive treatment is low, and that this is associated with a greater risk of hospitalization for cardiovascular events. In this study, we used a healthcare database to study the factors involved in discontinuation of antihypertensive drug prescriptions in real life. The analysis was restricted to 493 623 new users of antihypertensive drugs (no prescriptions in the previous 3 years) recruited in 2003, 2006 and 2009. Discontinuation was defined as lack of prescription renewal for at least 3 months. Each patient was followed at most for 1 year. The adjusted risk of treatment discontinuation depended on the type of initial antihypertensive treatment (diuretic monotherapy associated with higher risk) and it was lower in men (-17%) and older (-21 to -29%) patients, in patients with co-treatment with antidiabetic drugs, or hospitalization for cardiovascular or renal disease (-12 to -27%), but greater in patients under co-treatment with antidepressant drugs or hospitalization for concomitant pulmonary, rheumatic, neoplastic or neurological diseases (+9 to +32%). An unexpected relationship between discontinuation of treatment and density of the population of patient's residence, with a much greater discontinuation in metropolitan areas, was observed. In a real life setting, discontinuation of antihypertensive treatment is affected in an opposite direction by a large number of factors: type of antihypertensive treatment, co-treatments, clinical conditions and even demographic characteristics of the geographical area where the patient lives. Knowledge of these factors may help the effort to reduce this phenomenon.

Beliefs about medicines in Dutch acenocoumarol and phenprocoumon users

Adherence to the generally complex regimen of coumarin derivatives is vital in order to keep patients in the adequate International Normalized Ratio range. Patients' beliefs about medicines are associated with the level of therapy adherence. Our first aim was to assess beliefs about coumarins. Secondly, we compared the beliefs about coumarins with the beliefs about other cardiovascular drugs. The Beliefs about Medicines Questionnaire was used to assess medication beliefs. The questionnaire was completed by new users of coumarins indicated for venous thromboembolism or atrial fibrillation. A necessity score and a concerns score were calculated for all patients. The analyses were repeated for users of antihypertensive drugs or statins (not using coumarins). Three hundred and twenty patients were included in the analysis of the beliefs about coumarins. The mean necessity score was 15.3, the concerns score 12.3 and the necessity-concerns differential 3.0. Patients with venous thromboembolism (n = 71) had higher necessity scores than patients with atrial fibrillation (n = 249; 16.8 vs. 14.9, P < 0.001). The mean necessity score in 493 users of other cardiovascular drugs was 16.1, the concerns score 13.5 and the necessity-concerns differential 2.6. The necessity score was higher in chronic cardiovascular drug users (n = 192) than in new users (n = 301; 17.9 vs. 14.9, P < 0.001). Coumarin users score higher on the necessity scale than on the concerns scale, which is also the case in users of other cardiovascular drugs. Patients with atrial fibrillation have a less positive attitude towards these drugs than patients with venous thromboembolism, and could therefore benefit more from specific attention.

Antihypertensive Drug Prescribing and Persistence Among New Elderly Users: Implications for Persistence Improvement Interventions

BackgroundThe objective of this study was to examine persistence rates and factors influencing persistence for new elderly users of antihypertensive drugs. MethodsWe conducted a population-based cohort study in Ontario of adults aged 66 years or older to identify new users of antihypertensive medications between 1999 and 2010. Two-year therapy and class persistence were defined as persistence on any antihypertensive medication and persistence only on the same antihypertensive medication class, respectively. ResultsFrom 1999-2010, the prevalence of antihypertensive drug use increased from 47.8%-60.5% (P < 0.0001). Persistence was evaluated in 420,148 new users of antihypertensive drugs. After 2 years, therapy persistence was 58.9% and varied according to initial class prescribed, from 52.3% for diuretics to 64.1% for angiotensin-converting enzyme inhibitors. Class persistence ranged from 25.3% for diuretics to 35.8% for angiotensin II receptor blockers. Therapy persistence rates were greater in new users from more recent years (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.21-1.27). Subgroups that demonstrated poorer persistence included patients older than 75 years (aOR, 0.95; 95% CI, 0.94-0.96), those with lowest neighbourhood income quintile (aOR, 0.81; 95% CI, 0.80-0.83 compared with the highest quintile), those from urban vs rural areas (aOR, 0.83; 95% CI, 0.81-0.84), and those who started on diuretics as initial monotherapy compared with all other drug classes. ConclusionsAlthough 2-year therapy and class persistence were low for new users of antihypertensive drugs, improvements have occurred over the past decade. Our data highlight subgroups to target for future persistence improvement interventions.

Abstract W P348: Evaluating Gaps in the Continuum of Stroke Care

Background and Purpose: Medication adherence is an important factor for secondary stroke prevention in ambulatory care. We aimed to evaluate short-term adherence to antihypertensive and lipid-lowering agents after a new ischemic stroke as a predictor of adherence at one and two years after discharge. Methods: A five-year cohort (2003-2008) of patients from eleven institutions participating in the Registry of the Canadian Stroke Network (RCSN) was linked to population-based administrative health records. Patients with a diagnosis of an acute ischemic stroke who were discharged home were included in the study. Medication adherence was assessed through documentation of a filled prescription at seven days, one year and two years from hospital discharge. Results: From 2003 to 2008, 6,437 ischemic stroke patients were discharged home from hospital. A total of 1126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of hospital discharge. Patients provided with a prescription at discharge were more likely to be adherent to antihypertensive and lipid-lowering agents at seven days than patients who did not receive a prescription . Adherence at one year (X% vs Y%, p-value=?) was higher in patients who demonstrated adherence at seven days from discharge for antihypertensive (93.8% vs 87.7%, p&lt;0.0001), lipid-lowering agents (88% vs 81.9%, p&lt;0.0001), or both (85.8% vs 79.9%, p&lt;0.0001). Similar findings are noted at two years for antihypertensives (92.2% vs 87.7%, p=0.0003), lipid-lowering agents (82.6% vs 79.0%, p=0.0394), or both (81.1% vs 77.0%, p=0.0099). Conclusion: Filling prescriptions within one week of discharge from hospital for acute ischemic stroke predicts adherence for secondary preventive therapies at one and two years. Provision of a prescription at the time of discharge to both prior and new users of anti-hypertensive and lipid-lowering drugs is a simple and effective intervention to improve adherence to secondary preventive medications at seven days, one year and two years after ischemic stroke.

Antihypertensive medications and survival in patients with cancer: A population-based retrospective cohort study

Background: The association between antihypertensive medications and survival in cancer patients remains unclear. Objectives: To explore the association between classes of antihypertensive drugs and survival in cancer patients. Methods: Provincial Cancer Registry data was linked with a Provincial Drug Program Information Network (DPIN) for patients with lung (n=4241), colorectal (n=3967), breast (n=4019) or prostate (n=3355) cancer between the years of 2004 and 2008. Cox regression analyses were used to compare survival of patients using beta blockers (BBs), angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARB), calcium channel blockers (CCBs) or thiazide diuretics (TDs) to survival of patients who did not use any of these antihypertensive drugs. Survival of patients using only one class of antihypertensive drugs were compared to each other, with BBs as the reference class. Results: Compared to the antihypertensive drug non-user cohort, BBs had no effect on survival for any of the cancers. ACEi/ARBs use was weakly associated with increased deaths for breast cancer (HR: 1.22, 95% CI: 1.04–1.44) and lung cancer (HR: 1.11, 95% CI: 1.03–1.21) patients. Deaths were also increased with CCB use in patients with breast cancer (HR: 1.22, 95% CI: 1.02–1.47) and with TD use in lung cancer patients (HR: 1.1, 95% CI: 1.01–1.19). There was strong evidence (p-value <0.0001) of an increase in deaths with TD use for colorectal (HR: 1.28, 95% CI: 1.15–1.42), and prostate (HR 1.41, 1.2–1.65) cancer patients. When including only antihypertensive drug users prescribed one drug class, lung cancer patients receiving CCBs had improved survival compared to BBs (HR 0.79, 95% CI: 0.64–0.98). Conclusions: Some classes of antihypertensive agents are associated with a decreased survival in certain cancers. The decrease could be due to more comorbidities in antihypertensive drug users. However, CCB use was associated with improved survival in lung cancer patients.

NSAID–antihypertensive drug interactions: Which outpatients are at risk for a rise in systolic blood pressure?

Management guidelines for drug-drug interactions between non-steroidal anti-inflammatory drugs (NSAIDs) and antihypertensives recommend blood pressure monitoring in hypertensive patients. We measured the short-term effect of initiating NSAIDs on systolic blood pressure (SBP) in users of antihypertensives, aiming to investigate which outpatients are at risk for an increase in SBP in daily clinical practice. A cohort study with a nested case-control design in Dutch community pharmacies. Patients with a drug-drug interaction alert for a newly initiated NSAID and antihypertensive were interviewed and their SBP was measured at T0, after one week (T1) and after two weeks (T2). We evaluated risk factors for exceeding a predefined limit of change (PLoC) in SBP (≥ 10 mmHg to ≥ 140 mmHg) at T1 and T2 versus T0. For 112 patients the SBP at T0 was measured. Two patients were excluded (T0 SBP ≥ 180 mmHg). PLoC was exceeded in 10 patients (10.4%) at T1 and in seven patients (8.0%) at T2. Patients using etoricoxib (odds ratio (OR), 21.0; 95% confidence interval (CI), 3.7-120.6) and patients using >1 defined daily dose of an NSAID (OR, 3.3; 95% CI, 1.1-10.0) were at increased risk of a rise in SBP. A newly initiated NSAID has an immediate clinically relevant effect on SBP in some users of antihypertensives. Management guidelines for NSAID-antihypertensive drug-drug interactions should advise SBP monitoring before and after initiation of an NSAID or intensification of NSAID therapy. Monitoring is especially relevant in patients prescribed high dosages of NSAIDs. Etoricoxib should not be used in hypertensive patients.

Angiotensin‐Converting Enzyme Inhibitors and Alzheimer's Disease Progression in Older Adults: Results from the Réseau sur la Maladie d'Alzheimer Français Cohort

To assess whether angiotensin-converting enzyme inhibitor (ACE-I) treatment is associated with less cognitive decline in older adults with Alzheimer's disease (AD) than in those using other hypertensive or no drugs. Four-year prospective multicenter cohort study with a biannual assessment. Memory clinics from 16 university hospitals in France. Community-dwelling older adults with mild to moderate AD (N = 616). Participants were stratified into four groups according to type and duration of antihypertensive drug treatment. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). Linear mixed-effects models were used to assess differences in decline in MMSE score between the four groups. Hypertension at each visit was included in the model. Sixty-one participants had used ACE-Is continuously, 57 had used them intermittently, 189 had used other antihypertensive drugs, and 309 never used any antihypertensive drugs. Continuous ACE-Is users had a 4-year decline in MMSE of 6.4 ± 1.6 points (P < .001), intermittent ACE-Is users of 7.9 ± 1.1 points (P < .001), continuous or intermittent users of other antihypertensive drugs of 8.8 ± 0.7 points (P < .001), and never-users of 10.2 ± 0.6 points (P < .001). MMSE decline between the four groups was significantly different (adjusted P = .02). In subgroup analysis, the 118 (19.2%) participants who had continuously or intermittently used ACE-Is had a significant difference in 4-year MMSE decline from the 498 (80.8%) who had never used ACE-Is (7.5 ± 0.9 vs 9.7 ± 0.4; P = .03). The use of ACE-Is in older adults with AD is associated with a slower rate of cognitive decline independent of hypertension. Future research is needed to explore the role of ACE-Is in long-term AD progression.

The risk of falls on initiation of antihypertensive drugs in the elderly

Antihypertensive drugs are associated with an immediate increased falls risk in elderly patients which was significant during the first 14 days after receiving a thiazide diuretic, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-adrenergic blocker. Fall prevention strategies during this period may prevent fall-related injuries. The purpose of this study is to evaluate if initiation of the common antihypertensive drugs is associated with the occurrence of falls. This population-based self-controlled case series study used healthcare administrative databases to identify new users of antihypertensive drugs in the elderly aged 66 and older living in Ontario, Canada who suffered a fall from April 1, 2000 to March 31, 2009. The risk period was the first 45 days following antihypertensive therapy initiation, further subdivided into 0-14 and 15-44 days with control periods before and after treatment in a 450-day observation period. We calculated the relative incidence (incidence rate ratio, IRR), defined as the rate of falls in the risk period compared to falls rate in the control periods. Of the 543,572 new users of antihypertensive drugs among community-dwelling elderly, 8,893 experienced an injurious fall that required hospital care during the observation period. New users had a 69 % increased risk of having an injurious fall during the first 45 days following antihypertensive treatment (IRR = 1.69; 95 % CI, 1.57-1.81). This finding was consistent for thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers but not angiotensin II receptor antagonists. There was also an increased falls risk during the first 14 days of antihypertensive drug initiation (IRR = 1.94; 95 % CI, 1.75-2.16), which was consistent for all antihypertensive drug classes. This study suggests that initiation of antihypertensive drugs is a risk factor for falls in the elderly. Fall prevention strategies during this period may reduce injuries.