Blood Pressure Treatment Adherence Reduces Mortality, Regardless of Frailty

Giuseppe Mancia, MD

A new review of more than 1.2 million seniors is shedding light on the benefits of antihypertensive therapy on improving outcomes in older adults.

Results of the analysis, which indicate greater treatment adherence could result in 33-44% reductions in mortality over a 7-year period, underscore the importance of treatment adherence in older adults and frail patients.

“Our findings definitely suggest that even in very frail people, antihypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group,” said lead investigator Giuseppe Mancia, MD, professor emeritus at the University of Milano-Bicocca in Milan, Italy, in a statement from the American Heart Association.

Using the Healthcare Utilization databases from the Lombary Region of Italy, Mancia and a team of investigators designed the current analysis to assess associations between adherence with antihypertensive drugs and the risk of death in frail versus nonfrail old individuals. From the databases, investigators identified 1,283,602 subjects for inclusion in their analysis.

All patients included in the analysis were 65 years of age or older and received 3 or more prescriptions for antihypertensive medications from 2011-2012. Investigators pointed out exclusion criteria required patients to be beneficiaries of the National Health Service for at least 5 years before index date and reach at least 6 months of follow-up. Additionally, those institutionalized in long-term residential settings were excluded from the analysis.

Patients included in the analysis were followed from index date until death, emigration, or June 30, 2018. Of note, the date of the third antihypertensive prescription was considered index date for participants.

Of note, investigators performed additional analyses evaluating effects based on scores on a previously validated 34-item cardiovascular and noncardiovascular condition index. Using this, participants were classified as being of good (0-4), medium (5-9), poor (10-14), or very poor (15 or more) clinical status.

From the 1,283,602 patient-cohort, which had a mean age of 76 years, investigators obtained 7,579,381 person-years of follow-up data, including 225,228 deaths. For the purpose of the analysis, investigators compared those who died during the follow-up period with a cohort of age-, gender-, and health-status-matched controls who survived.

Results of the analysis indicated in 7-year death probability increased progressively from 16-64% based on baseline clinical status. Compared with patients who spent less than 25% of follow-up period covered by prescriptions, those with high adherence, which was considered coverage for 75% or more of the period, was associated with a decreased risk of all-cause mortality. Investigators noted the specific decrease in risk varied depending on if a patient was of good (44%), medium (43%), poor (40%), and very poor (33%) clinical status at baseline.

Similar results were observed in a separate analysis examining risk of cardiovascular mortality. Among patients in this analysis, the greatest survival benefit was noted in patients of good health at baseline while the most modest survival benefit was in those with very poor health at baseline.

“Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don’t take them,” Mancia added, in the aforementioned statement.

This study, “Antihypertensive Treatment in Elderly Frail Patients Evidence From a Large Italian Database,” was published in Hypertension.