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Adherence to Antihypertensive and Cardiovascular Preventive Treatment: The Contribution of the Lombardy Database

  • Giuseppe Mancia
  • Federico Rea
  • Giovanni Corrao
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

This chapter addresses the issue of adherence to cardiovascular prevention therapies, largely based on the analysis of the Lombardy health utilization databases, which include all residents of this region of northern Italy (>10 million). In Italy free or about free health care is provided for all citizens, including antihypertensive, lipid lowering, and antidiabetic drugs upon prescription. This allows to assess adherence from prescription renewal over extended periods. The main results showed that (1) adherence to antihypertensive drug treatment was low with >60% of the patients discontinuing treatment for prolonged periods during the observation time; (2) demographic and clinical factors were involved in this phenomenon which also depended to a pronounced degree on the type of initial treatment, i.e. different monotherapies and drug combinations; (3) similar results were obtained for adherence to statin treatment; and (4) there was a significant positive relationship between reduced adherence to treatment and increased risk of hospitalization for coronary disease, cerebrovascular disease, and heart failure. This was the case in younger and older patients, including those >85 years. Thus, adherence to treatment can substantially modify the beneficial effects of cardiovascular drugs for cardiovascular prevention, as documented by clinical trials. This calls for research approaches that extend the results of trial to their application to medical practice.

Keywords

Antihypertensive treatment Statins Cardiovascular prevention Adherence to treatment Cardiovascular disease 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giuseppe Mancia
    • 1
    • 2
  • Federico Rea
    • 3
  • Giovanni Corrao
    • 3
  1. 1.University of Milano-BicoccaMilanItaly
  2. 2.Policlinico di MonzaMonzaItaly
  3. 3.Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative MethodsUniversity of Milano-BicoccaMilanItaly

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