Study: Adherence to Blood Pressure Drugs Improves Survival in Frail Seniors

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A new study published in the journal Hypertension found that taking blood pressure medication as prescribed helped the frailest elderly patients live longer, and the healthiest elder patients had the biggest survival boost.

“We knew that high blood pressure medication was protective in general among older people, however, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomized trials,” said lead author Giuseppe Mancia, MD, professor emeritus at the University of Milano-Bicocca in Milan, Italy, in a press release.

Using the public health care database of the Lombardy region in Italy, researchers examined data from >1.2 million people aged ≥65 years (mean age 76) who had ≥3 prescriptions of antihypertensive medication between 2011 and 2012.

Researchers calculated the percentage of time over the next 7 years (or until death) that each participant continued to receive the medications, and because almost all medications are free or low-cost and dispensed by the public health service in Italy, this corresponds with medication adherence.

The follow-up period was 7 years and medication adherence were measured by the proportion of the follow-up covered by prescriptions, and the analysis was performed separately in patients with a good, medium, poor, and very poor health status.

Health status was assessed by a score that has been shown to be a sensitive predictor of mortality in the Italian population and accounts for 34 different health factors.

Results

Researchers compared roughly 255 000 people who died during follow-up with age-, gender-, and health-status-matched controls who survived and divided them into 4 groups of health status: good, medium, poor or very poor.

They found that the probability of mortality over 7 years was 16% for patients rated in good health at the beginning of the study and increased to 64% for those with very poor health.

Compared with patients with very low adherence to antihypertensive medications (pills covered <25% of the time period), those with high adherence (>75% of the time period) were:

• 44% less likely to die if they started in good health
• 33% less likely to die if they started in very poor health

Similar results were seen with cardiovascular deaths as the greatest survival benefit was seen among patients who started in good health and the most modest survival benefit was in those who started in very poor health.

Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don’t take them.

Regardless of a patient’s initial health status, survival benefits were greatest in those who received blood pressure medication to cover >75% of the follow-up period vs those with intermediate (25%-75%) or low levels (<25%) of coverage.

“Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don’t take them,” said Mancia.

It should be noted that because all study data were from Italy, where hospitalizations and blood pressure medications are available for free or at a low cost, the results may not be generalizable to countries with differing health systems. In addition, the national database did not include information on prescription medications given to elderly patients in nursing homes in Italy, so the results may only apply to elderly patients living in the community.