Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention
Keywords:
antihypertensive, persistence to treatment, clinical outcomes, percutaneous coronary intervention
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition that carries a high risk of recurrent cardiovascular events and death. Persistence to treatment is known to reduce disease morbidity and mortality in patients with ACS. In this study, we focus on ACS patients undergoing their first percutaneous coronary intervention (PCI) to investigate the association between persistence to antihypertensive therapy and clinical outcomes. A retrospective cohort study with two years of follow-up was conducted with 367 patients recruited. Patients were deemed as having the persistence to antihypertensive therapy (C02, C03, C07, C08, C09) if the gap between prescriptions was ≤ 30 days. The clinical outcomes are defined as a composite of major adverse cardiac event (MACE), major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, recurrent PCI, stroke, all-cause death, cardiovascular death, and hospitalization. Cumulative persistence to antihypertensive showed 72.3% of ACS patients still taking antihypertensive one year after PCI. Persistence to treatment with antihypertensive therapy can be used as a predictor of MACE or MACCE because it was associated with recurrent PCI (RR 1.94, 95% CI = 1.02-3.71). Our study indicates that among ACS patients undergoing their first PCI, non-persistence to antihypertensive therapy may lead to worse clinical outcomes. This data will be useful to promote secondary prevention in ACS patients after PCI.
References
Ah, Y., Lee, J., Choi, Y., Kim, B., Choi, K., & Kong, J. et al. (2015). Persistence with Antihypertensive Medications in Uncomplicated Treatment-Naïve Patients: Effects of Initial Therapeutic Classes. Journal of Korean Medical Science, 30(12), 1800. https://doi.org/10.3346/jkms.2015.30.12.1800
Alharbi, F., Souverein, P., de Groot, M., Maitland-van der Zee, A., de Boer, A., & Klungel, O. (2017). Risk of acute myocardial infarction after discontinuation of antihypertensive agents: a case–control study. Journal Of Human Hypertension, 31(8), 537-544. https://doi.org/10.1038/jhh.2017.1
Allonen, J., Nieminen, M., & Sinisalo, J. (2020). Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event. Annals of Medicine, 52(3-4), 74-84. https://doi.org/10.1080/07853890.2020.1740938
Bundhun, P., Wu, Z., & Chen, M. (2015). Impact of Modifiable Cardiovascular Risk Factors on Mortality after Percutaneous Coronary Intervention. Medicine, 94(50), e2313. https://doi.org/10.1097/md.0000000000002313
Carubelli, V., Lombardi, C., Specchia, C., Peveri, G., Oriecuia, C., & Tomasoni, D. et al. (2021). Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta‐blockers in patients hospitalized for acute heart failure. ESC Heart Failure, 8(3), 1944-1953. https://doi.org/10.1002/ehf2.13223
Corrao, G., Parodi, A., Nicotra, F., Zambon, A., Merlino, L., Cesana, G., & Mancia, G. (2011). Better compliance to antihypertensive medications reduces cardiovascular risk. Journal of hypertension, 29(3), 610–618. https://doi.org/10.1097/HJH.0b013e328342ca97
Desta, L., Khedri, M., Jernberg, T., Andell, P., Mohammad, M., & Hofman‐Bang, C. et al. (2020). Adherence to beta‐blockers and long‐term risk of heart failure and mortality after a myocardial infarction. ESC Heart Failure, 8(1), 344-355. https://doi.org/10.1002/ehf2.13079
Febrinasari, R., Martohusodo, B., Kristin, E., Nindrea, R., & Dwiprahasto, I. (2019). Comparing the effect of Angiotensin-Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers in heart failure patients with type 2 diabetes mellitus: a systematic review. Bali Medical Journal, 8(3), 757. https://doi.org/10.15562/bmj.v8i3.1534
Georgiopoulos, G., Tsioufis, C., Tsiachris, D., Dimitriadis, K., Kasiakogias, A., & Lagiou, F. et al. (2016). Metabolic syndrome, independent of its components, affects adversely cardiovascular morbidity in essential hypertensives. Atherosclerosis, 244, 66-72. https://doi.org/10.1016/j.atherosclerosis.2015.10.099
Grimmsmann, T., & Himmel, W. (2013). Persistence of antihypertensive drug use in German primary care: a follow-up study based on pharmacy claims data. European Journal Of Clinical Pharmacology, 70(3), 295-301. https://doi.org/10.1007/s00228-013-1607-4
Hou, Y., Yue, Y., Zhao, M., & Jiang, S. (2019). Prevalence and association of medication nonadherence with major adverse cardiovascular events in patients with myocardial infarction. Medicine, 98(44), e17826. https://doi.org/10.1097/md.0000000000017826
Iqbal, J., Zhang, Y., Holmes, D., Morice, M., Mack, M., & Kappetein, A. et al. (2015). Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting. Circulation, 131(14), 1269-1277. https://doi.org/10.1161/circulationaha.114.013042
Kanda, D., Miyata, M., Ikeda, Y., Tokushige, A., Sonoda, T., & Arikawa, R. et al. (2022). The Priority of Non-HDL-C Assessment to Predict New Lesions among Stable Angina Patients with Strong Statins. Journal of Atherosclerosis And Thrombosis, 29(6), 894-905. https://doi.org/10.5551/jat.62908
Kawashiri, M., Sakata, K., Hayashi, K., Gamou, T., Kanaya, H., & Miwa, K. et al. (2016). Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study. Heart and Vessels, 32(5), 539-548. https://doi.org/10.1007/s00380-016-0910-2
Kim, Y., Her, A., Jeong, M., Kim, B., Hong, S., & Kim, S. et al. (2019). Which is the worst risk factor for the long‐term clinical outcome? Comparison of long‐term clinical outcomes between antecedent hypertension and diabetes mellitus in South Korean acute myocardial infarction patients after stent implantation. Journal of Diabetes, 12(2), 119-133. https://doi.org/10.1111/1753-0407.12979
Maron, D., Boden, W., Spertus, J., Hartigan, P., Mancini, G., & Sedlis, S. et al. (2011). Impact of Metabolic Syndrome and Diabetes on Prognosis and Outcomes with Early Percutaneous Coronary Intervention in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial. Journal of The American College Of Cardiology, 58(2), 131-137. https://doi.org/10.1016/j.jacc.2011.02.046
Qvarnström, M., Kahan, T., Kieler, H., Brandt, L., Hasselström, J., & Boström, K. et al. (2016). Persistence to antihypertensive drug classes. Medicine, 95(40), e4908. https://doi.org/10.1097/md.0000000000004908
Rahhal, A., Mahfouz, A., Khir, F., Okleh, N., Aljundi, A., & AlKhalaila, O. et al. (2020). Medications adherence post‐primary percutaneous coronary intervention in acute myocardial infarction: A population‐based cohort study. Journal of Clinical Pharmacy And Therapeutics, 46(3), 772-779. https://doi.org/10.1111/jcpt.13348
Reuter, H., Markhof, A., Scholz, S., Wegmann, C., Seck, C., & Adler, C. et al. (2014). Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention. European Journal of Preventive Cardiology, 22(7), 890-898. https://doi.org/10.1177/2047487314540385
Saluveer, O., Redfors, B., Angerås, O., Dworeck, C., Haraldsson, I., & Ljungman, C. et al. (2017). Hypertension is associated with increased mortality in patients with ischaemic heart disease after revascularization with percutaneous coronary intervention – a report from SCAAR. Blood Pressure, 26(3), 166-173. https://doi.org/10.1080/08037051.2016.1270162
Si, S., Ofori-Asenso, R., Briffa, T., Sanfilippo, F., Ilomaki, J., & Qin, X. et al. (2019). Long-term persistence and adherence to blood pressure lowering agents among older Australians. Pharmacoepidemiology And Drug Safety, 28(6), 788-795. https://doi.org/10.1002/pds.4742
Watanabe, H., Ozasa, N., Morimoto, T., Shiomi, H., Bingyuan, B., & Suwa, S. et al. (2018). Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PLOS ONE, 13(8), e0199347. https://doi.org/10.1371/journal.pone.0199347
Alharbi, F., Souverein, P., de Groot, M., Maitland-van der Zee, A., de Boer, A., & Klungel, O. (2017). Risk of acute myocardial infarction after discontinuation of antihypertensive agents: a case–control study. Journal Of Human Hypertension, 31(8), 537-544. https://doi.org/10.1038/jhh.2017.1
Allonen, J., Nieminen, M., & Sinisalo, J. (2020). Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event. Annals of Medicine, 52(3-4), 74-84. https://doi.org/10.1080/07853890.2020.1740938
Bundhun, P., Wu, Z., & Chen, M. (2015). Impact of Modifiable Cardiovascular Risk Factors on Mortality after Percutaneous Coronary Intervention. Medicine, 94(50), e2313. https://doi.org/10.1097/md.0000000000002313
Carubelli, V., Lombardi, C., Specchia, C., Peveri, G., Oriecuia, C., & Tomasoni, D. et al. (2021). Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta‐blockers in patients hospitalized for acute heart failure. ESC Heart Failure, 8(3), 1944-1953. https://doi.org/10.1002/ehf2.13223
Corrao, G., Parodi, A., Nicotra, F., Zambon, A., Merlino, L., Cesana, G., & Mancia, G. (2011). Better compliance to antihypertensive medications reduces cardiovascular risk. Journal of hypertension, 29(3), 610–618. https://doi.org/10.1097/HJH.0b013e328342ca97
Desta, L., Khedri, M., Jernberg, T., Andell, P., Mohammad, M., & Hofman‐Bang, C. et al. (2020). Adherence to beta‐blockers and long‐term risk of heart failure and mortality after a myocardial infarction. ESC Heart Failure, 8(1), 344-355. https://doi.org/10.1002/ehf2.13079
Febrinasari, R., Martohusodo, B., Kristin, E., Nindrea, R., & Dwiprahasto, I. (2019). Comparing the effect of Angiotensin-Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers in heart failure patients with type 2 diabetes mellitus: a systematic review. Bali Medical Journal, 8(3), 757. https://doi.org/10.15562/bmj.v8i3.1534
Georgiopoulos, G., Tsioufis, C., Tsiachris, D., Dimitriadis, K., Kasiakogias, A., & Lagiou, F. et al. (2016). Metabolic syndrome, independent of its components, affects adversely cardiovascular morbidity in essential hypertensives. Atherosclerosis, 244, 66-72. https://doi.org/10.1016/j.atherosclerosis.2015.10.099
Grimmsmann, T., & Himmel, W. (2013). Persistence of antihypertensive drug use in German primary care: a follow-up study based on pharmacy claims data. European Journal Of Clinical Pharmacology, 70(3), 295-301. https://doi.org/10.1007/s00228-013-1607-4
Hou, Y., Yue, Y., Zhao, M., & Jiang, S. (2019). Prevalence and association of medication nonadherence with major adverse cardiovascular events in patients with myocardial infarction. Medicine, 98(44), e17826. https://doi.org/10.1097/md.0000000000017826
Iqbal, J., Zhang, Y., Holmes, D., Morice, M., Mack, M., & Kappetein, A. et al. (2015). Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting. Circulation, 131(14), 1269-1277. https://doi.org/10.1161/circulationaha.114.013042
Kanda, D., Miyata, M., Ikeda, Y., Tokushige, A., Sonoda, T., & Arikawa, R. et al. (2022). The Priority of Non-HDL-C Assessment to Predict New Lesions among Stable Angina Patients with Strong Statins. Journal of Atherosclerosis And Thrombosis, 29(6), 894-905. https://doi.org/10.5551/jat.62908
Kawashiri, M., Sakata, K., Hayashi, K., Gamou, T., Kanaya, H., & Miwa, K. et al. (2016). Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study. Heart and Vessels, 32(5), 539-548. https://doi.org/10.1007/s00380-016-0910-2
Kim, Y., Her, A., Jeong, M., Kim, B., Hong, S., & Kim, S. et al. (2019). Which is the worst risk factor for the long‐term clinical outcome? Comparison of long‐term clinical outcomes between antecedent hypertension and diabetes mellitus in South Korean acute myocardial infarction patients after stent implantation. Journal of Diabetes, 12(2), 119-133. https://doi.org/10.1111/1753-0407.12979
Maron, D., Boden, W., Spertus, J., Hartigan, P., Mancini, G., & Sedlis, S. et al. (2011). Impact of Metabolic Syndrome and Diabetes on Prognosis and Outcomes with Early Percutaneous Coronary Intervention in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial. Journal of The American College Of Cardiology, 58(2), 131-137. https://doi.org/10.1016/j.jacc.2011.02.046
Qvarnström, M., Kahan, T., Kieler, H., Brandt, L., Hasselström, J., & Boström, K. et al. (2016). Persistence to antihypertensive drug classes. Medicine, 95(40), e4908. https://doi.org/10.1097/md.0000000000004908
Rahhal, A., Mahfouz, A., Khir, F., Okleh, N., Aljundi, A., & AlKhalaila, O. et al. (2020). Medications adherence post‐primary percutaneous coronary intervention in acute myocardial infarction: A population‐based cohort study. Journal of Clinical Pharmacy And Therapeutics, 46(3), 772-779. https://doi.org/10.1111/jcpt.13348
Reuter, H., Markhof, A., Scholz, S., Wegmann, C., Seck, C., & Adler, C. et al. (2014). Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention. European Journal of Preventive Cardiology, 22(7), 890-898. https://doi.org/10.1177/2047487314540385
Saluveer, O., Redfors, B., Angerås, O., Dworeck, C., Haraldsson, I., & Ljungman, C. et al. (2017). Hypertension is associated with increased mortality in patients with ischaemic heart disease after revascularization with percutaneous coronary intervention – a report from SCAAR. Blood Pressure, 26(3), 166-173. https://doi.org/10.1080/08037051.2016.1270162
Si, S., Ofori-Asenso, R., Briffa, T., Sanfilippo, F., Ilomaki, J., & Qin, X. et al. (2019). Long-term persistence and adherence to blood pressure lowering agents among older Australians. Pharmacoepidemiology And Drug Safety, 28(6), 788-795. https://doi.org/10.1002/pds.4742
Watanabe, H., Ozasa, N., Morimoto, T., Shiomi, H., Bingyuan, B., & Suwa, S. et al. (2018). Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PLOS ONE, 13(8), e0199347. https://doi.org/10.1371/journal.pone.0199347
Published
2023-09-04
How to Cite
Kristin, E., Dinarti, L. K., Febrinasari, R., Pratiwi, W. R., Yasmina, A., & Jaya, S. I. (2023). Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention. Indonesian Journal of Pharmacy, 34(3), 482–490. https://doi.org/10.22146/ijp.5499
Issue
Section
Research Article
