Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans
Open Access
- 24 September 2015
- journal article
- research article
- Published by S. Karger AG in American Journal of Nephrology
- Vol. 42 (2), 151-157
- https://doi.org/10.1159/000440685
Abstract
Background: Adherence is paramount in treating hypertension; however, no gold standard method is available for non-adherence screening, delineating high-risk patients. An International Classification of Diseases 9th Edition non-adherence diagnostic code (V15.81) has been available for decades; but, its utility is poorly studied. We examined the association between the V15.81 code assigned prior to the initiation of anti-hypertensive drugs (AHDs) and renal and cardiovascular outcomes. Methods: This was a historical prospective cohort study involving 312,489 newly treated hypertensive individuals (mean age 53.8 years, 90.9% males, 20.3% black, median follow-up 8.0 years). We used crude and Cox models adjusted for baseline socio-demographic characteristics, estimated glomerular filtration rate (eGFR), body mass index, blood pressure, comorbidities, and prospective AHD adherence (measured as proportion of days covered, PDC). Results: In the unadjusted analysis, the V15.81 code was associated with higher risks for faster eGFR decline (hazard ratio, HR 1.22, 95% CI 1.11-1.33), incident CKD (HR 1.17, 95% CI 1.09-1.27), end-stage renal disease (ESRD) (HR 2.53, 95% CI 1.72-3.72), incident coronary artery disease (CAD) (HR 1.26, 95% CI 1.15-1.38), and stroke (HR 1.55, 95% CI 1.38-1.73). In the adjusted model, the V15.81 code remained predictive of increased risk of CKD (HR 1.33, 95% CI 1.22-1.45), ESRD (HR 1.81, 95% CI 1.18-2.78), incident CAD (HR 1.26, 95% CI 1.14-1.40), and stroke (HR 1.46, 95% CI 1.29-1.65). Additional adjustment for PDC did not alter adverse associations between V15.81 code and studied outcomes. Conclusions: Assignment of V15.81 code prior to AHD therapy was associated with higher risks of renal and cardiovascular outcomes in incident hypertensive US veterans. Previous history of non-adherence is a poor prognostic marker in hypertensive individuals; therefore, patients with V15.81 code may require close monitoring. The observational nature of this study limits our ability to make firm recommendations for clinical practice.Keywords
This publication has 24 references indexed in Scilit:
- Adherence to antihypertensive agents improves risk reduction of end-stage renal diseaseKidney International, 2013
- The USRDSClinical Journal of the American Society of Nephrology, 2013
- Outcomes Associated With Microalbuminuria: Effect Modification by Chronic Kidney DiseaseJournal of the American College of Cardiology, 2013
- Hyponatremia, Hypernatremia, and Mortality in Patients With Chronic Kidney Disease With and Without Congestive Heart FailureCirculation, 2012
- Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patientsClinicoEconomics and Outcomes Research, 2011
- Medication AdherenceCirculation, 2009
- Impact of a Better Adherence to Antihypertensive Agents on Cerebrovascular Disease for Primary PreventionStroke, 2009
- The effect of discontinuation of antihypertensives on the risk of acute myocardial infarction and strokeCurrent Medical Research and Opinion, 2008
- The effect of discontinuation of antihypertensives on the risk of acute myocardial infarction and strokeCurrent Medical Research and Opinion, 2007