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Hypertension. 2019 Jul 1:HYPERTENSIONAHA11912907. doi: 10.1161/HYPERTENSIONAHA.119.12907. [Epub ahead of print]

Association of Total Medication Burden With Intensive and Standard Blood Pressure Control and Clinical Outcomes: A Secondary Analysis of SPRINT.

Author information

1
From Kaiser Permanente Colorado, Aurora (C.G.D., J.B.K.).
2
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO (C.G.D., K.E.T., J.J.S.).
3
University of Texas at Austin, Austin, TX (T.H.G.).
4
University of Utah, School of Medicine, Salt Lake City, UT (A.P.B., J.S.H., T.H.G., J.B.K.).
5
Columbia University Medical Center, New York, NY (A.E.M., I.M.K.).
6
MedStar Washington Hospital Center, Washington, DC (W.S.W.).
7
Fielding School of Public Health, University of California Los Angeles, CA (D.E.M.).
8
School of Medicine, University of Colorado, Aurora, CO (K.E.T., J.J.S., M.C.).
9
Kaiser Permanente Southern California, Pasadena, CA (K.R.).
10
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (J.T.B.).
11
Baylor College of Medicine, Houston, TX (J.T.B.).
12
Boston University School of Public Health, MA (D.R.B.).
13
Stanford University School of Medicine, CA (T.I.C.).
14
Memphis Veteran's Affairs Medical Center, Memphis, TN (W.C.C.).
15
University of Tennessee Health Science Center, Memphis, TN (W.C.C.).
16
Wake Forest School of Medicine, Winston-Salem, NC (C.G.F., N.M.P.).
17
Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (C.T.H.).
18
New York University Langone School of Medicine, New York, NY (L.A.K.).
19
Tulane University School of Medicine and Public Health and Tropical Medicine, New Orleans, LA (M.K.-W.).
20
Ochsner Health System, New Orleans, LA (M.K.-W.).
21
School of Medicine, University of Miami, FL (L.T.).

Abstract

Total medication burden (antihypertensive and nonantihypertensive medications) may be associated with poor systolic blood pressure (SBP) control. We investigated the association of baseline medication burden and clinical outcomes and whether the effect of the SBP intervention varied according to baseline medication burden in SPRINT (Systolic Blood Pressure Intervention Trial). Participants were randomized to intensive or standard SBP goal (below 120 or 140 mm Hg, respectively); n=3769 participants with high baseline medication burden (≥5 medications) and n=5592 with low burden (<5 medications). Primary outcome: differences in SBP. Secondary outcomes: 8-item Morisky Medication Adherence Scale and modified Treatment Satisfaction Questionnaire for Medications measured at baseline and 12 months and incident cardiovascular disease events and serious adverse events throughout the trial. Participants in the intensive group with high versus low medication burden were less likely to achieve their SBP goal at 12 months (risk ratio, 0.91; 95% CI, 0.85-0.97) but not in the standard group (risk ratio, 0.98; 95% CI, 0.93-1.03; Pinteraction<0.001). High medication burden was associated with increased cardiovascular disease events (hazard ratio, 1.39; 95% CI, 1.14-1.70) and serious adverse events (hazard ratio, 1.34; 95% CI, 1.24-1.45), but the effect of intensive versus standard treatment did not vary between medication burden groups ( Pinteraction>0.5). Medication burden had minimal association with adherence or satisfaction. High baseline medication burden was associated with worse intensive SBP control and higher rates of cardiovascular disease events and serious adverse events. The relative benefits and risks of intensive SBP goals were similar regardless of medication burden. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT01206062.

KEYWORDS:

blood pressure; cardiovascular diseases; hypertension; medication adherence; risk

PMID:
31256717
PMCID:
PMC6938559
[Available on 2021-01-01]
DOI:
10.1161/HYPERTENSIONAHA.119.12907

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