Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans.
Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans.
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DOI：
10.1159/000440685
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发表时间：
2015
影响因子：
4.2
通讯作者：
Kovesdy CP
中科院分区：
文献类型：
--
作者：
Gosmanova EO;Molnar MZ;Alrifai A;Lu JL;Streja E;Cushman WC;Kalantar-Zadeh K;Kovesdy CP
坚持治疗高血压至关重要；然而，没有金标准方法可用于非依从性筛查描绘高危患者。ICD-9-CM不依从性诊断代码（V15.81）已有几十年的历史；然而，对其效用的研究却很少。我们研究了抗高血压药物（AHD）开始前分配的V15.81代码与肾脏和心血管结局之间的关系。这是一项历史前瞻性队列研究，涉及312,489名新治疗的高血压患者（平均年龄53.8岁，90.9%为男性，20.3%为黑人，中位随访8.0年）。我们使用粗模型和Cox模型，调整了基线社会、人口统计学特征、肾小球滤过率（eGFR）、BMI、血压、合并症和预期AHD依从性（以覆盖天数的比例，PDC）。在未经调整的分析中，V15.81编码与eGFR快速下降（HR1.22, [95% CI] 1.11-1.33）、CKD （HR1.17[1.09-1.27]）、ESRD （HR2.53[1.72-3.72]）、冠心病（HR1.26[1.15-1.38]）和卒中（HR1.55[1.38-1.73]）相关。在调整后的模型中，V15.81代码仍然可以预测CKD （HR1.33[1.22-1.45]）、ESRD （HR1.81[1.18-2.78]）、冠心病（HR1.26[1.14-1.40]）和卒中（HR1.46[1.29-1.65]）风险的增加。额外调整PDC并没有改变V15.81编码与研究结果之间的不良关联。在美国高血压退伍军人中，在AHD治疗前分配V15.81代码与肾脏和心血管结局的高风险相关。既往不依从史是高血压患者预后不良的标志；因此，携带V15.81代码的患者可能需要密切监测。本研究的观察性质限制了我们对临床实践提出坚定建议的能力。
Adherence is paramount in treating hypertension; still, no gold standard method is available for non-adherence screening delineating high-risk patients. An ICD-9-CM non-adherence diagnostic code (V15.81) has been available for decades; however, its utility is poorly studied. We examined the association between V15.81 code assigned prior to initiation of antihypertensive drugs (AHD) and renal and cardiovascular outcomes. This was a historical prospective cohort study involving 312,489 newly treated hypertensive individuals (mean age 53.8years, 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), BMI, blood pressure, co-morbidities, and prospective AHD adherence (measured as proportion of days covered,PDC). In unadjusted analysis, V15.81 code was associated with higher risks for faster eGFR decline (HR1.22, [95% CI] 1.11-1.33), incident CKD (HR1.17 [1.09-1.27]), ESRD (HR2.53 [1.72-3.72]), incident coronary artery disease (CAD) (HR1.26 [1.15-1.38), and stroke (HR1.55 [1.38-1.73]). In adjusted model, V15.81 code remained predictive of increased risk of CKD (HR1.33 [1.22-1.45]), ESRD (HR1.81 [1.18-2.78]), incident CAD (HR1.26 [1.14-1.40]), and stroke (HR1.46 [1.29-1.65]). Additional adjustment for PDC did not alter adverse associations between V15.81 code and studied outcomes. 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.