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.
Original language | English (US) |
---|---|
Pages (from-to) | 267-275 |
Number of pages | 9 |
Journal | Hypertension |
Volume | 74 |
Issue number | 2 |
DOIs | |
State | Published - Aug 1 2019 |
Keywords
- blood pressure
- cardiovascular diseases
- hypertension
- medication adherence
- risk
ASJC Scopus subject areas
- Internal Medicine
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Association of Total Medication Burden with Intensive and Standard Blood Pressure Control and Clinical Outcomes : A Secondary Analysis of SPRINT. / Derington, Catherine G.; Gums, Tyler H.; Bress, Adam P.; Herrick, Jennifer S.; Greene, Tom H.; Moran, Andrew E.; Weintraub, William S.; Kronish, Ian M.; Morisky, Donald E.; Trinkley, Katy E.; Saseen, Joseph J.; Reynolds, Kristi; Bates, Jeffrey T.; Berlowitz, Dan R.; Chang, Tara I.; Chonchol, Michel; Cushman, William C.; Foy, Capri G.; Herring, Charles T.; Katz, Lois Anne; Krousel-Wood, Marie; Pajewski, Nicholas M.; Tamariz, Leonardo; King, Jordan B.
In: Hypertension, Vol. 74, No. 2, 01.08.2019, p. 267-275.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Association of Total Medication Burden with Intensive and Standard Blood Pressure Control and Clinical Outcomes
T2 - A Secondary Analysis of SPRINT
AU - Derington, Catherine G.
AU - Gums, Tyler H.
AU - Bress, Adam P.
AU - Herrick, Jennifer S.
AU - Greene, Tom H.
AU - Moran, Andrew E.
AU - Weintraub, William S.
AU - Kronish, Ian M.
AU - Morisky, Donald E.
AU - Trinkley, Katy E.
AU - Saseen, Joseph J.
AU - Reynolds, Kristi
AU - Bates, Jeffrey T.
AU - Berlowitz, Dan R.
AU - Chang, Tara I.
AU - Chonchol, Michel
AU - Cushman, William C.
AU - Foy, Capri G.
AU - Herring, Charles T.
AU - Katz, Lois Anne
AU - Krousel-Wood, Marie
AU - Pajewski, Nicholas M.
AU - Tamariz, Leonardo
AU - King, Jordan B.
N1 - Funding Information: This work was supported by R01HL139837 from the National Heart, Lung, and Blood Institute, Bethesda, MD. A.P. Bress is supported by K01HL133468 and R01HL139837 from the NHLBI (National Heart, Lung, and Blood Institute), Bethesda, MD. A.E. Moran is supported by R01HL130500-01A1 and R01HL139837 from the NHLBI, Bethesda, MD. I.M. Kronish is supported by UL1-TR001873 from the National Center for Advancing Translational Sciences. Additional support was provided by the University of Utah Study Design and Biostatistics Center, with funding in part from the Public Health Services research grant numbers UL1-RR025764 and C06-RR11234 from the National Center for Research Resources. Additional support was provided by K24HL125704 from the NHLBI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI or the National Institutes of Health (NIH). We thank the other investigators, the staff, and the participants of SPRINT (Systolic Blood Pressure Intervention Trial) for their valuable contributions. SPRINT is funded with Federal funds from the NIH, including the NHLBI, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke, under Contract Numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900 048C, HHSN268200900049C, and Inter-Agency Agreement Number A-HL-13-002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. The SPRINT investigators acknowledge the contribution of study medications (azilsartan and azilsartan combined with chlorthalidone) from Takeda Pharmaceuticals International, Inc. All components of the SPRINT study protocol were designed and implemented by the investigators. The investigative team collected, analyzed, and interpreted the data. All aspects of article writing and revision were performed by the coauthors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the US Department of Veterans Affairs, or the United States Government. For a full list of contributors to SPRINT, please see the supplementary acknowledgment list: https://www.sprinttrial.org/public/dspScience. cfm. We also acknowledge the support from the following Clinical and Translational Science Awards funded by National Center for Advancing Translational Sciences: Case Western Reserve University: UL1TR000439, OSU: UL1RR025755, University of Pennsylvania: UL1RR024134& UL1TR000003, Boston: UL1RR025771, Stanford: UL1TR000093, Tufts: UL1RR025752, UL1TR000073 and UL1TR001064, University of Illinois: UL1TR000050, University of Pittsburgh: UL1TR000005, UT Southwestern: 9U54TR000017-06, University of Utah: UL1TR000105-05, Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of CA, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, Tulane University: P30GM103337 Centers of Biomedical Research Excellence Award National Institute of General Medical Sciences. Funding Information: This work was supported by R01HL139837 from the National Heart, Lung, and Blood Institute, Bethesda, MD. A.P. Bress is supported by K01HL133468 and R01HL139837 from the NHLBI (National Heart, Lung, and Blood Institute), Bethesda, MD. A.E. Moran is supported by R01HL130500-01A1 and R01HL139837 from the NHLBI, Bethesda, MD. I.M. Kronish is supported by UL1-TR001873 from the National Center for Advancing Translational Sciences. Additional support was provided by the University of Utah Study Design and Biostatistics Center, with funding in part from the Public Health Services research grant numbers UL1-RR025764 and C06-RR11234 from the National Center for Research Resources. Additional support was provided by K24HL125704 from the NHLBI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI or the National Institutes of Health (NIH). We thank the other investigators, the staff, and the participants of SPRINT (Systolic Blood Pressure Intervention Trial) for their valuable contributions. SPRINT is funded with Federal funds from the NIH, including the NHLBI, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke, under Contract Numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and Inter-Agency Agreement Number A-HL-13-002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. The SPRINT investigators acknowledge the contribution of study medications (azilsartan and azilsartan combined with chlorthalidone) from Takeda Pharmaceuticals International, Inc. All components of the SPRINT study protocol were designed and implemented by the investigators. The investigative team collected, analyzed, and interpreted the data. All aspects of article writing and revision were performed by the coauthors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the US Department of Veterans Affairs, or the United States Government. For a full list of contributors to SPRINT, please see the supplementary acknowledgment list: https://www.sprinttrial.org/public/dspScience.cfm. We also acknowledge the support from the following Clinical and Translational Science Awards funded by National Center for Advancing Translational Sciences: Case Western Reserve University: UL1TR000439, OSU: UL1RR025755, University of Pennsylvania: UL1RR024134& UL1TR000003, Boston: UL1RR025771, Stanford: UL1TR000093, Tufts: UL1RR025752, UL1TR000073 and UL1TR001064, University of Illinois: UL1TR000050, University of Pittsburgh: UL1TR000005, UT Southwestern: 9U54TR000017-06, University of Utah: UL1TR000105-05, Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of CA, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, Tulane University: P30GM103337 Centers of Biomedical Research Excellence Award National Institute of General Medical Sciences.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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.
AB - 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.
KW - blood pressure
KW - cardiovascular diseases
KW - hypertension
KW - medication adherence
KW - risk
UR - http://www.scopus.com/inward/record.url?scp=85073670566&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073670566&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.119.12907
DO - 10.1161/HYPERTENSIONAHA.119.12907
M3 - Article
C2 - 31256717
AN - SCOPUS:85073670566
VL - 74
SP - 267
EP - 275
JO - Hypertension
JF - Hypertension
SN - 0194-911X
IS - 2
ER -