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Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial

Journal of Human Hypertension volume 30, pages 73–78 (2016)Cite this article

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Abstract

Lower adherence to antihypertensive medications may increase visit-to-visit variability of blood pressure (VVV of BP), a risk factor for cardiovascular events and death. We used data from the African American Study of Kidney Disease and Hypertension (AASK) trial to examine whether lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive chronic kidney disease (CKD). Determinants of VVV of BP were also explored. AASK participants (n=988) were categorized by self-report or pill count as having perfect (100%), moderately high (75–99%), moderately low (50–74%) or low (<50%) proportion of study visits with high medication adherence over a 1-year follow-up period. We used multinomial logistic regression to examine determinants of medication adherence, and multivariable-adjusted linear regression to examine the association between medication adherence and systolic VVV of BP, defined as the coefficient of variation or the average real variability (ARV). Participants with lower self-reported adherence were generally younger and had a higher prevalence of comorbid conditions. Compared with perfect adherence, moderately high, moderately low and low adherence was associated with 0.65% (±0.31%), 0.99% (±0.31%) and 1.29% (±0.32%) higher systolic VVV of BP (defined as the coefficient of variation) in fully adjusted models. Results were qualitatively similar when using ARV or when using pill counts as the measure of adherence. Lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive CKD; efforts to improve medication adherence in this population may reduce systolic VVV of BP.

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Acknowledgements

The AASK trial was conducted by the AASK Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data from AASK reported here were supplied by the NIDDK Central Repositories. This manuscript was not prepared in collaboration with Investigators of the AASK study and does not necessarily reflect the opinions or views of the AASK study, the NIDDK Central Repositories, or the NIDDK. Dr. Ian Kronish received support from the National Heart, Lung, and Blood Institute (K23 HL-098359). Dr. Tara Chang (TIC) received support from the NIDDK (K23 DK095914), and from the Stanford Prevention Research Center Innovation Award in Population Science.

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Authors and Affiliations

  1. Stanford University School of Medicine, Stanford, CA, USA

    K Hong

  2. Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL, , USA

    P Muntner

  3. Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University College of Physician & Surgeons, New York, NY, USA

    I Kronish

  4. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA

    D Shilane

  5. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    T I Chang

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  1. K Hong
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Correspondence to T I Chang.

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Hong, K., Muntner, P., Kronish, I. et al. Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial. J Hum Hypertens 30, 73–78 (2016). https://doi.org/10.1038/jhh.2015.26

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