{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:14:05Z","timestamp":1790957645622,"version":"4.1.0"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,11,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Antihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              ); few studies have examined this association among older adults.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We assessed this association among Medicare fee\u2010for\u2010service beneficiaries aged 66 to 79\u00a0years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008\u20132009 (n=155\u00a0597). We calculated proportion of days covered (\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              ) during follow\u2010up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              outcomes, including first incident of fatal\/nonfatal acute myocardial infarction, ischemic heart disease, stroke\/transient ischemic attack, and heart failure. During follow\u2010up (median 5.8\u00a0years and 798\u00a0621\u00a0person\u2010years), we documented 47\u00a0198\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              \u226580%, 40% to 79%, and &lt;40%. Crude incidence of\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events were 40.1 (95% CI, 40.0\u201340.1), 93.9 (93.8\u201393.9), and 98.1 (98.1\u201398.2) per 1000\u00a0person\u2010years for\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              \u226580%, 40% to 79%, and &lt;40%, respectively. Adjusted hazard ratios for\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events were 1.0 (&lt;40% as reference), 1.0 (0.97\u20131.03) for 40% to 79%, and 0.44 (0.42\u20130.45) for \u226580% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Dose\u2010response analysis suggested a nonlinear relationship between\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              and risk for\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events with a protective effect of \u226580%. The pattern of associations between\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              and ischemic heart disease, stroke\/transient ischemic attack, and heart failure were largely consistent as for\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events and across different groups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Antihypertensive adherence was associated with a significantly lower risk of\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events among older adults. There appeared to be a threshold effect in reducing\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              events at around\n              <jats:styled-content style=\"fixed-case\">PDC<\/jats:styled-content>\n              80%, above which the risk for\n              <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n              reduced substantially.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.006056","type":"journal-article","created":{"date-parts":[[2017,6,25]],"date-time":"2017-06-25T00:10:16Z","timestamp":1498349416000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":108,"title":["Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population\u2010Based Cohort Study"],"prefix":"10.1161","volume":"6","author":[{"given":"Quanhe","family":"Yang","sequence":"first","affiliation":[{"name":"Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anping","family":"Chang","sequence":"additional","affiliation":[{"name":"Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Ritchey","sequence":"additional","affiliation":[{"name":"Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleetwood","family":"Loustalot","sequence":"additional","affiliation":[{"name":"Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000350"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.19.2560"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284427"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200320030-00006"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.768986"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjopharm.2011.02.004"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.01.008"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.162"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.111.176859"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.hco.0000126978.03828.9e"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2009.02.007"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.12.011"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.830299"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.2.177"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38875.675486.55"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000163641.86870.af"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.08.021"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0090733"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000382"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.116.07720"},{"key":"e_1_3_5_22_2","unstructured":"Ortman JM Velkoff VA Hogan H. An aging nation: the older population in the United States. Population Estimates and Projections. 2014. Available at: https:\/\/www.census.gov\/prod\/2014pubs\/p25-1140.pdf. Accessed January 8 2017."},{"key":"e_1_3_5_23_2","first-page":"144","article-title":"Prevalence of hypertension and controlled hypertension\u2014United States, 2007\u20132010","volume":"62","author":"Gillespie CD","year":"2013","unstructured":"Gillespie CD, Hurvitz KA; Centers for Disease C and Prevention . Prevalence of hypertension and controlled hypertension\u2014United States, 2007\u20132010. MMWR Suppl. 2013;62:144\u2013148.","journal-title":"MMWR Suppl"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6544a2"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.3422"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.39"},{"key":"e_1_3_5_27_2","first-page":"1","article-title":"Prevalence of obesity among adults and youth: United States, 2011\u20132014","volume":"219","author":"Ogden CL","year":"2015","unstructured":"Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011\u20132014. NCHS Data Brief. 2015;219:1\u20138.","journal-title":"NCHS Data Brief"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwg231"},{"key":"e_1_3_5_29_2","unstructured":"Nau DP. Proportion of days covered (PDC) as a preferred method of measuring medication adherence. Available at: http:\/\/pqaalliance.org\/resources\/adherence.asp. Accessed May 22 2017."},{"key":"e_1_3_5_30_2","first-page":"457","article-title":"Measuring concurrent adherence to multiple related medications","volume":"15","author":"Choudhry NK","year":"2009","unstructured":"Choudhry NK, Shrank WH, Levin RL, Lee JL, Jan SA, Brookhart MA, Solomon DH. Measuring concurrent adherence to multiple related medications. Am J Manag Care. 2009;15:457\u2013464.","journal-title":"Am J Manag Care"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-006-0090-y"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_5_36_2","first-page":"815","article-title":"Adherence to multiple medications prescribed for a chronic disease: a methodological investigation","volume":"20","author":"Basak R","year":"2014","unstructured":"Basak R, McCaffrey Iii DJ, Bentley JP, Przybyla SM, West\u2010Strum D, Banahan BF. Adherence to multiple medications prescribed for a chronic disease: a methodological investigation. J Manag Care Spec Pharm. 2014;20:815\u2013823.","journal-title":"J Manag Care Spec Pharm"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2006.12.3.239"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0792"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.115.06731"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.10.048"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S15619"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e328342ca97"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht295"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.010676"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12171"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2013.00091"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200421120-00004"},{"key":"e_1_3_5_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.03.1631"},{"key":"e_1_3_5_49_2","first-page":"CD000011","article-title":"Interventions for enhancing medication adherence","volume":"11","author":"Nieuwlaat R","year":"2014","unstructured":"Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;11:CD000011.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1D268"},{"key":"e_1_3_5_51_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.5841"},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1110421"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.006056","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:33:09Z","timestamp":1715596389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.006056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,6]]},"references-count":51,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,11,6]]}},"alternative-id":["10.1161\/JAHA.117.006056"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.006056","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,6]]},"assertion":[{"value":"2017-03-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-04-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006056"}}