According to results from a large, nested, case-control study published in Hypertension, adherence to antihypertensive treatment was associated with a reduced risk of cardiovascular mortality among elderly patients, including frail individuals, although the benefit is less marked than in patients with a good clinical status.
Dr. Giuseppe Mancia et al conducted a nested, case-control study to ascertain the relationship between adherence to antihypertensive therapy and the risk of death in frail versus nonfrail elderly patients. The study authors used the database of the Lombardy Region in Italy to identify 1,283,602 residents aged ≥65 years (mean age 76 years) who had at least three antihypertensive drug prescriptions between 2011 and 2012. Adherence, which was calculated by the proportion of the follow-up covered by prescriptions, was evaluated for all patients based on clinical status (i.e., good, medium, poor, very poor). Clinical status was measured using the Multisource Comorbidity Score, which has been proven to be a sensitive predictor of death in the Italian population.
The study results disclosed that the probability of death over the 7-year follow-up period increased from 16% in the good clinical status group to 64% for patients who were considered to be in very poor health. The study authors noted, “Compared with patients with very low adherence with antihypertensive treatment (<25% of follow-up time covered by prescriptions), those with high adherence (>75% of time covered by prescriptions) exhibited a lower risk of all-cause mortality in each group, the difference decreasing progressively (–44%, –43%, –40%, and –33%) from the good to the very poor clinical status.”
The researchers concluded that adherence to antihypertensive drug treatment was linked to a smaller risk of cardiovascular mortality. Additionally, adherence to antihypertensive appears to be protective in frail, old patients. Dr. Mancia,said, “Our findings definitely suggest that even in very frail individuals, antihypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group.”
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