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 |
| Externally published | Yes |
Fingerprint
Keywords
- blood pressure
- cardiovascular diseases
- hypertension
- medication adherence
- risk
ASJC Scopus subject areas
- Internal Medicine
Cite this
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
}
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.
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 -