Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications
고혈압환자에서 고혈압 약물 순응도가 심혈관 질환 사망 및 입원에 미치는 영향

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dc.description학위논문 (박사)-- 서울대학교 대학원 : 의학과, 2016. 8. 조비룡.-
dc.description.abstractObjective: The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease (CVD) has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific CVD mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction).
Methods: Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged 20 years or older, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003–2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence (CMA). Subjects were divided into good (CMA≥80%), intermediate (CMA 50–80%), and poor (CMA<50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. The potential predictors of adherence to antihypertensive medication during first two year were evaluated through a multiple logistic regression model
Results: Patients with poor medication adherence had worse mortality from IHD (HR: 1.64, 95% CI: 1.16–2.31, P for trend=0.005), cerebral hemorrhage (H HR: 2.71, 95% CI: 1.65–4.47, P for trend<0.001), and heart failure (HR: 2.07, 95% CI: 1.05-6.74, P for trend=0.030) than those with good adherence. The estimated HRs of hospitalization for CVD were consistent with the mortality endpoint. High income level (OR: 0.82, 95% CI: 0.77–0.86), and taking multiple antihypertensive drug (OR: 0.86, 95% CI: 0.82–0.91), dyslipidemia (OR: 0.90, 95% CI: 0.83–0.96) were associated with good adherence to antihypertensive medication.
Conclusions: Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific CVDs, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.
dc.description.tableofcontentsIntroduction 1
1. Hypertension and cardiovascular disease 1
2. Concept of medication adherence 1
3. Methods of assessing medication adherence 3
4. Adherence to antihypertensive medication and clinical outcomes 5
5. Study for Korean population 6
6. The aim of study 7

Methods 9
1. Data source 9
2. Study subjects 10
3. Assessment of adherence 13
4. Outcomes 15
5. Statistical analysis 15

Results 18
1. Subject characteristics 18
2. Adherence to antihypertensive medications and CVD mortality 21
3. Adherence to antihypertensive medications and hospitalization for CVD 28
4. Adherence to antihypertensive medications and CVD outcomes in non-CVD hospitalization subset (N=12991) 35
5. Factors affecting adherence to antihypertensive medication 38

Discussion 41

Conclusion 50

References 51

Abstract in Korean 58
dc.format.extent608763 bytes-
dc.publisher서울대학교 대학원-
dc.subjectmedication adherence-
dc.titleMedication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications-
dc.title.alternative고혈압환자에서 고혈압 약물 순응도가 심혈관 질환 사망 및 입원에 미치는 영향-
dc.contributor.AlternativeAuthorSoyeun Kim-
dc.contributor.affiliation의과대학 의학과-
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Theses (Ph.D. / Sc.D._의학과)
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