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Abstract
Objective High blood pressure is a modifiable risk factor for stroke, but non-adherence to antihypertensive medication is a growing concern for healthcare providers in controlling blood pressure. This study aimed to investigate the effect of adherence to antihypertensive medication on stroke incidence.
Design Retrospective cohort study.
Setting We analysed National Health Insurance claim data and check-up data from 2009 to 2013.
Participants 38520patients with hypertension were defined as those diagnosed with hypertension and prescribed antihypertensive medication.
Interventions No interventions were made.
Outcome measure Poisson regression analysis using generalised estimating equations models was performed to examine the association between adherence to antihypertensive medication and stroke incidence.
Results Among 38 520 patients with hypertension, 957 (2.5%) strokes occurred during the study period. Non-adherence to medication was significantly associated with a higher risk of stroke (intermediate adherence: adjusted relative risk (aRR)=1.13, 95% CI=1.06 to 1.21; poor adherence: aRR=1.27, 95% CI=1.17 to 1.38).
Conclusions Non-adherence to antihypertensive medication in patients with hypertension was associated with an increased risk of stroke. Therefore, healthcare providers need to focus on interventional strategies to ensure that these patients adhere to medication therapy and to provide continuing support to achieve long-term adherence, ultimately minimising negative health outcomes.
- cohort study
- high blood pressure
- hypertension
- medication adherence
- stroke
- South Korea
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Footnotes
Contributors HJL designed the study, performed statistical analyses and wrote the manuscript. HJL, S-IJ and E-CP contributed to the Discussion section and reviewed and edited the manuscript. E-CP is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The English in this document has been checked by at least two professional editors, both native English speakers.
Competing interests None declared.
Patient consent We used encrypted data from which personal information could not be identified.
Ethics approval The Institutional Review Board, Yonsei University Graduate School of Public Health.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data are available from the Korean National Health Insurance Service (NHIS), but access to confidential data is limited to researchers who meet the necessary criteria; basically, any researcher who proposes a study subject and plans with a standardised proposal form and are approved by the NHIS review committee on research support can access the raw data. Details of this process and a provision guide are now available at http://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do.