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A 13-year survey of bacteraemia due to beta-haemolytic streptococci in a Danish county.

https://arctichealth.org/en/permalink/ahliterature35255
Source
J Med Microbiol. 1995 Jul;43(1):63-7
Publication Type
Article
Date
Jul-1995
Author
B. Kristensen
H C Schønheyder
Author Affiliation
Department of Clinical Microbiology, Aalborg Hospital, Denmark.
Source
J Med Microbiol. 1995 Jul;43(1):63-7
Date
Jul-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Bacteremia - epidemiology - microbiology
Cardiovascular Diseases - complications
Child
Child, Preschool
Cross Infection - epidemiology - microbiology
Denmark - epidemiology
Diabetes Complications
Female
Hemolysis
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Recurrence
Skin Diseases, Bacterial - complications
Streptococcal Infections - epidemiology - microbiology
Streptococcus - classification - isolation & purification
Streptococcus agalactiae - classification - isolation & purification
Streptococcus pyogenes - classification - isolation & purification
Urinary Tract Infections - complications
Abstract
During 1981-1993, 229 episodes of bacteraemia due to beta-haemolytic streptococci of groups A, B, C and G were diagnosed in the County of Northern Jutland, Denmark. The annual rates for bacteraemia were quite constant during the 13-year period for each streptococcal group. Group A streptococcal (GAS) bacteraemia was the most frequent, comprising 1.4% of all bacteraemias. The incidence of GAS bacteraemia was 1.8/100,000/year in children 60 years old. With the notable exception of group B streptococcal (GBS) bacteraemia in neonates, beta-haemolytic streptococci of groups B, C (GCS) and G (GGS) were isolated mostly from elderly patients. Except for GBS bacteraemia in neonates, approximately one-third of the bacteraemias in each group was nosocomially acquired. Predisposing factors included operative procedures in GAS and GCS bacteraemia, and diabetes mellitus in GBS bacteraemia. The skin was the most common primary focus in GAC, GCC and GGS bacteraemias, whereas the urinary tract was the commonest focus in GBS bacteraemia in adults. The mortality rates in GAS, GCS, GGS, and adult GBS bacteraemia were 23%, 16%, 17% and 19%, respectively. Of the 23 fatal cases of GAS bacteraemia, 57% died within 24 h after blood cultures had been obtained.
PubMed ID
7608958 View in PubMed
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The 2000 Canadian recommendations for the management of hypertension: part two--diagnosis and assessment of people with high blood pressure.

https://arctichealth.org/en/permalink/ahliterature192030
Source
Can J Cardiol. 2001 Dec;17(12):1249-63
Publication Type
Conference/Meeting Material
Article
Date
Dec-2001
Author
K B Zarnke
M. Levine
F A McAlister
N R Campbell
M G Myers
D W McKay
P. Bolli
G. Honos
M. Lebel
K. Mann
T W Wilson
C. Abbott
S. Tobe
E. Burgess
S. Rabkin
Author Affiliation
Department of Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada. Kelly.Zarnke@lhsc.on.ca
Source
Can J Cardiol. 2001 Dec;17(12):1249-63
Date
Dec-2001
Language
English
French
Publication Type
Conference/Meeting Material
Article
Keywords
Adrenal Gland Neoplasms - complications
Adult
Blood Pressure Determination - methods - psychology - standards
Blood Pressure Monitoring, Ambulatory - methods - standards
Canada
Cardiovascular Diseases - etiology - prevention & control
Clinical Laboratory Techniques - standards
Diabetes Complications
Diabetic Nephropathies - complications - diagnosis
Echocardiography - standards
Electrocardiography
Evidence-Based Medicine - methods
Humans
Hypertension - complications - diagnosis - etiology - psychology
Hypertension, Renovascular - diagnosis
Hypertrophy, Left Ventricular - complications - ultrasonography
Office Visits
Patient compliance
Pheochromocytoma - complications - diagnosis
Risk factors
Self Care - methods - standards
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults.
For people with high blood pressure, the assignment of a diagnosis of hypertension depends on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the duration of follow-up and the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases. For people diagnosed with hypertension, defining the overall risk of adverse cardiovascular outcomes requires laboratory testing, a search for target organ damage and an assessment of the modifiable causes of hypertension. Out-of-clinic blood pressure assessment and echocardiography are options for selected patients.
People at increased risk of adverse cardiovascular outcomes and were identified and quantified.
Medline searches were conducted from the period of the last revision of the Canadian recommendations for the management of hypertension (May 1998 to October 2000). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other studies. All relevant articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts.
A high value was placed on the identification of people at increased risk of cardiovascular morbidity and mortality.
The identification of people at higher risk of cardiovascular disease will permit counselling for lifestyle manoeuvres and the introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The present document contains detailed recommendations pertaining to aspects of the diagnosis and assessment of patients with hypertension, including the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, routine and optional laboratory testing, assessment for renovascular hypertension, home and ambulatory blood pressure monitoring, and the role of echocardiography in hypertension.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only the recommendations achieving high levels of consensus are reported here. These guidelines will be updated annually.
These recommendations are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control of Health Canada.
PubMed ID
11773936 View in PubMed
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2011 Canadian Hypertension Education Program recommendations: an annual update.

https://arctichealth.org/en/permalink/ahliterature128763
Source
Can Fam Physician. 2011 Dec;57(12):1393-7
Publication Type
Article
Date
Dec-2011
Author
Norm Campbell
Source
Can Fam Physician. 2011 Dec;57(12):1393-7
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Angiotensin Receptor Antagonists - therapeutic use
Canada
Diabetes Complications - complications
Diabetes Mellitus - drug therapy
Health education
Health Policy
Humans
Hypertension - complications - drug therapy - prevention & control
Life Style
Risk factors
Stroke - complications
Notes
Cites: Eur Heart J. 2001 Aug;22(15):1343-5211465967
Cites: Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):519-2320195154
Cites: Stroke. 2002 May;33(5):1315-2011988609
Cites: Can J Cardiol. 2002 Jun;18(6):657-6112107423
Cites: J Hypertens. 2004 Jan;22(1):11-915106785
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Cites: Fam Pract. 1997 Apr;14(2):160-769137956
Cites: Am J Hypertens. 1997 Oct;10(10 Pt 1):1097-1029370379
Cites: Arch Intern Med. 2005 Jun 27;165(12):1410-915983291
Cites: Can J Cardiol. 2007 May 1;23(6):437-4317487286
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Can J Cardiol. 2007 Dec;23(14):1124-3018060097
Cites: Circulation. 2008 Feb 12;117(6):743-5318212285
Cites: Lancet Neurol. 2008 May;7(5):391-918396107
Cites: Can J Cardiol. 2008 Jun;24(6):483-418548145
Cites: Can J Cardiol. 2008 Jun;24(6):485-9018548146
Cites: Can J Cardiol. 2008 Jun;24(6):497-118548148
Cites: Am J Hypertens. 2008 Nov;21(11):1210-518772857
Cites: Hypertension. 2009 Feb;53(2):128-3419114646
Cites: Can J Cardiol. 2009 May;25(5):279-8619417858
Cites: Can J Cardiol. 2009 May;25(5):299-30219417860
Cites: Eur Heart J. 2009 Jun;30(12):1434-919454575
Cites: J Hypertens. 2009 Jul;27(7):1472-719474763
Cites: Can J Cardiol. 2009 Aug;25(8):451-219668778
Cites: Arch Intern Med. 2009 Nov 23;169(21):1996-200219933962
Cites: Pharmacotherapy. 2010 Mar;30(3):228-3520180606
Cites: Health Rep. 2010 Mar;21(1):37-4620426225
Cites: N Engl J Med. 2010 Apr 29;362(17):1575-8520228401
Cites: Int J Stroke. 2010 Apr;5(2):110-620446945
Cites: Curr Opin Cardiol. 2010 Jul;25(4):366-7220502323
Cites: JAMA. 2002 Feb 27;287(8):1003-1011866648
PubMed ID
22170191 View in PubMed
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Source
J Obstet Gynaecol Can. 2002 Dec;24(12):938-40
Publication Type
Article
Date
Dec-2002
Author
Robert W Webster
Author Affiliation
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
Source
J Obstet Gynaecol Can. 2002 Dec;24(12):938-40
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cardiovascular Diseases - complications
Diabetes Complications
Female
Humans
Hypertension - complications
Indians, North American
MEDLINE
Menopause - psychology
Middle Aged
Vasomotor System - physiology
Abstract
OBJECTIVE: To determine the characteristics of menopause in Aboriginal women, in particular Canadian Aboriginal women. METHODS: An extensive review of articles extracted from both medical and non-medical databases was undertaken. The search strategy combined the key word "menopause" with any of the following terms: Aboriginals, Native Americans, Natives, Indians, Métis, Inuit, Eskimo, and Indigenous people. RESULTS: A total of 29 records were found, 13 of which had results relevant to the objective of the study. These articles suggest that menopause may have a positive effect on the lives of Aboriginal women with respect to increasing their freedom within the community. Aboriginal women appear to experience fewer vasomotor symptoms than other North American women. CONCLUSION: More research needs to be done to determine the effect menopause has on Canadian Aboriginal women and their coexisting diseases such as cardiovascular disease, hypertension, and diabetes mellitus. This work will allow health care providers to make more informed decisions on managing Aboriginal women's transition through menopause in areas such as hormone replacement therapy.
PubMed ID
12464991 View in PubMed
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Acetaminophen, aspirin, and chronic renal failure.

https://arctichealth.org/en/permalink/ahliterature47628
Source
N Engl J Med. 2001 Dec 20;345(25):1801-8
Publication Type
Article
Date
Dec-20-2001
Author
C M Fored
E. Ejerblad
P. Lindblad
J P Fryzek
P W Dickman
L B Signorello
L. Lipworth
C G Elinder
W J Blot
J K McLaughlin
M M Zack
O. Nyrén
Author Affiliation
Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. michael.fored@mep.ki.se
Source
N Engl J Med. 2001 Dec 20;345(25):1801-8
Date
Dec-20-2001
Language
English
Publication Type
Article
Keywords
Acetaminophen - adverse effects
Analgesics, Non-Narcotic - adverse effects
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Aspirin - adverse effects
Bias (epidemiology)
Case-Control Studies
Diabetes Complications
Dose-Response Relationship, Drug
Drug Therapy, Combination
Humans
Kidney Failure, Chronic - chemically induced
Logistic Models
Odds Ratio
Questionnaires
Research Support, Non-U.S. Gov't
Risk factors
Sweden
Abstract
BACKGROUND: Several epidemiologic studies have demonstrated an association between heavy consumption of nonnarcotic analgesics and the occurrence of chronic renal failure, but it is unclear which is the cause and which is the effect METHODS: In a nationwide, population-based, case-control study of early-stage chronic renal failure in Sweden, face-to-face interviews were conducted with 926 patients with newly diagnosed renal failure and 998 control subjects, of whom 918 and 980, respectively, had complete data. We used logistic-regression models to estimate the relative risks of disease-specific types of chronic renal failure associated with the use of various analgesics RESULTS: Aspirin and acetaminophen were used regularly by 37 percent and 25 percent, respectively, of the patients with renal failure and by 19 percent and 12 percent, respectively, of the controls. Regular use of either drug in the absence of the other was associated with an increase by a factor of 2.5 in the risk of chronic renal failure from any cause. The relative risks rose with increasing cumulative lifetime doses, rose more consistently with acetaminophen use than with aspirin use, and were increased for most disease-specific types of chronic renal failure. When we disregarded the recent use of analgesics, which could have occurred in response to antecedents of renal disease, the associations were only slightly attenuated CONCLUSIONS: Our results are consistent with the existence of exacerbating effects of acetaminophen and aspirin on chronic renal failure. However, we cannot rule out the possibility of bias due to the triggering of analgesic consumption by predisposing conditions.
Notes
Comment In: N Engl J Med. 2001 Dec 20;345(25):1844-611752364
Comment In: N Engl J Med. 2002 May 16;346(20):1588-9; author reply 1588-912015402
Comment In: N Engl J Med. 2002 May 16;346(20):1588-9; author reply 1588-912017163
PubMed ID
11752356 View in PubMed
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Adherence level of antihypertensive agents in coronary artery disease.

https://arctichealth.org/en/permalink/ahliterature146044
Source
Br J Clin Pharmacol. 2010 Jan;69(1):74-84
Publication Type
Article
Date
Jan-2010
Author
Sylvie Perreault
Alice Dragomir
Louise Roy
Michel White
Lucie Blais
Lyne Lalonde
Anick Bérard
Author Affiliation
Faculties of Pharmacy and Medicine, University of Montreal, Montreal, Quebec, Canada. sylvie.perreault@umontreal.ca
Source
Br J Clin Pharmacol. 2010 Jan;69(1):74-84
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antihypertensive Agents - therapeutic use
Case-Control Studies
Cohort Studies
Coronary Artery Disease - epidemiology - etiology - prevention & control
Diabetes Complications - prevention & control
Dyslipidemias - complications
Female
Humans
Hypertension - drug therapy
Incidence
Male
Medication Adherence
Middle Aged
Primary prevention - methods
Quebec - epidemiology
Risk factors
Survival Analysis
Abstract
* Non-adherence is probably an important source of preventable cardiovascular morbidity and mortality. * However, until now there have been very few large effectiveness studies assessing the relationship between adherence levels to antihypertensive medication and major cardiovascular outcomes for primary prevention of cardiovascular disease.
* The study results suggest that there is an association between better adherence to antihypertensive agents and a relative risk reduction of coronary artery disease. * Adherence to antihypertensive agents needs to be improved so that patients can benefit from the full protective effects of antihypertensive therapies.
Antihypertensive (AH) agents have been shown to reduce the risk of cardiovascular events, including coronary artery disease (CAD). Previous surveys have shown that a substantial number of patients with diagnosed hypertension remain uncontrolled. Non-adherence to AH agents may reduce the effectiveness. The aim was to evaluate the impact of better adherence to AH agents on the occurrence of CAD in a real clinical setting.
A cohort of 83 267 patients was reconstructed using the Régie de l'assurance maladie du Québec databases. Patients were eligible if they were between 45 and 85 years of age without indication of cardiovascular disease, and had been newly treated with AH agents between 1999 and 2004. A nested case-control design was used to study the incidence of CAD. Every case of CAD was matched for age and duration of follow-up to up to 15 randomly selected controls. The adherence level was measured by calculating the medication possession ratio. Cases' adherence was calculated from the start of follow-up to the time of the CAD (index date). For controls, adherence was calculated from the start of follow-up to the time of selection (index date). Rate ratios of CAD were estimated by conditional logistic regression adjusting for covariables.
The mean patient age was 65 years, 37% were male, 8% had diabetes and 18% had dyslipidaemia. High adherence level (96%) to AH therapy compared with lower adherence level (59%) was associated with a relative risk reduction of CAD events (rate ratios 0.90; 0.84, 0.95). Risk factors for CAD were male gender, diabetes, dyslipidaemia and developing a cardiovascular condition disease during follow-up.
Our study suggests that better adherence to AH agents is associated with a risk reduction of CAD. Adherence to AH agents needs to be improved so that patients can benefit from the full protective effects of AH therapies.
Notes
Cites: Am J Hypertens. 1997 Oct;10(10 Pt 1):1097-1029370379
Cites: J Clin Epidemiol. 1995 Aug;48(8):999-10097775999
Cites: N Engl J Med. 1999 Jan 7;340(1):14-229878640
Cites: Am J Epidemiol. 1999 Jun 1;149(11):981-310355372
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PubMed ID
20078615 View in PubMed
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Adherence to antihypertensive agents after ischemic stroke and risk of cardiovascular outcomes.

https://arctichealth.org/en/permalink/ahliterature119300
Source
Neurology. 2012 Nov 13;79(20):2037-43
Publication Type
Article
Date
Nov-13-2012
Author
Sylvie Perreault
Amy Y X Yu
Robert Côté
Alice Dragomir
Brian White-Guay
Stéphanie Dumas
Author Affiliation
Faculty of Pharmacy, University of Montreal, Faculty of Medicine, McGill University, Montreal, Canada. sylvie.perreault@umontreal.ca
Source
Neurology. 2012 Nov 13;79(20):2037-43
Date
Nov-13-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antihypertensive Agents - therapeutic use
Case-Control Studies
Cerebrovascular Disorders - epidemiology - prevention & control
Cohort Studies
Diabetes Complications - prevention & control
Dyslipidemias - drug therapy - epidemiology
Female
Humans
Ischemia - complications - epidemiology
Logistic Models
Male
Medication Adherence
Quebec
Reproducibility of Results
Retrospective Studies
Risk factors
Risk Reduction Behavior
Stroke - epidemiology - etiology - prevention & control
Abstract
To evaluate the relationship between antihypertensive (AH) drug adherence and cardiovascular (CV) outcomes among patients with a recent ischemic stroke and assess the validity of our approach.
A cohort of 14,227 patients diagnosed with an ischemic stroke was assembled from individuals 65 years and older who were treated with AH agents from 1999 to 2007 in Quebec, Canada. A nested case-control design was used to evaluate the occurrence of nonfatal major CV outcomes and mortality. Each case was matched to 15 controls by age and cohort entry time. Medication possession ratio was used for AH agent adherence level. Adjusted conditional logistic regression models were used to estimate the rate ratio of CV events. The validity of the approach was assessed by evaluating the adherence level of CV-protective and non-CV-protective drugs.
Mean age was 75 years, 54% were male, 38% had coronary artery disease, 23% had diabetes, 47% dyslipidemia, and 14% atrial fibrillation or flutter. High adherence to AH therapy was mirrored by similar adherence to statins and antiplatelet agents and was associated with a lower risk of nonfatal vascular events compared with lower adherence (rate ratio 0.77 [0.70-0.86]). We observed a paradoxic link between adherence to several drugs and all-cause mortality.
Adherence to AH agents is associated with adherence to other secondary preventive therapies and a risk reduction for nonfatal vascular events after an ischemic stroke. Overestimation of all-cause mortality reduction may be related to frailty and comorbidities, which may confound the apparent benefit of different drugs.
Notes
Cites: Lancet Neurol. 2009 Apr;8(4):345-5419233730
Cites: Stroke. 2009 Jan;40(1):213-2019038916
Cites: Circulation. 2009 Oct 20;120(16):1598-60519805653
Cites: Cerebrovasc Dis. 2010 Jan;29(2):146-5319955739
Cites: Am J Med. 2010 Mar;123(3 Suppl):S3-1120206730
Cites: Lancet. 2010 Mar 13;375(9718):906-1520226989
Cites: Lancet. 2010 Mar 13;375(9718):938-4820226991
Cites: Lancet Neurol. 2010 May;9(5):469-8020227347
Cites: J Clin Lipidol. 2010 Nov-Dec;4(6):462-7121122692
Cites: Int J Clin Pract. 2011 Jan;65(1):41-5321091596
Cites: Stroke. 2011 Feb;42(2):517-8421127304
Cites: Value Health. 2011 Jun;14(4):513-2021669377
Cites: Heart. 2011 Nov;97(22):1862-921586421
Cites: Lancet. 2001 Aug 25;358(9282):661-311530175
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Cites: Epidemiology. 2001 Nov;12(6):682-911679797
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Cites: Am Heart J. 2003 Oct;146(4):581-9014564310
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Cites: J Clin Epidemiol. 2004 Feb;57(2):131-4115125622
Cites: Hypertension. 2004 Oct;44(4):398-40415326093
Cites: J Clin Epidemiol. 1995 Aug;48(8):999-10097775999
Cites: Med Care. 1999 Sep;37(9):846-5710493464
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Cites: Hypertension. 2006 Aug;48(2):260-516785330
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Cites: Stroke. 2006 Oct;37(10):2493-816931783
Cites: Am J Hypertens. 2006 Nov;19(11):1190-617070434
Cites: Eur Heart J. 2008 Jul;29(13):1605-718523057
Cites: Am J Med. 2009 Jul;122(7):647-5519559167
PubMed ID
23115211 View in PubMed
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Adherence to antihypertensive agents improves risk reduction of end-stage renal disease.

https://arctichealth.org/en/permalink/ahliterature257023
Source
Kidney Int. 2013 Sep;84(3):570-7
Publication Type
Article
Date
Sep-2013
Author
Louise Roy
Brian White-Guay
Marc Dorais
Alice Dragomir
Myriam Lessard
Sylvie Perreault
Author Affiliation
Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
Source
Kidney Int. 2013 Sep;84(3):570-7
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antihypertensive Agents - therapeutic use
Canada
Cohort Studies
Diabetes Complications
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic - epidemiology - prevention & control
Longitudinal Studies
Male
Middle Aged
Patient compliance
Peripheral Vascular Diseases - complications
Proportional Hazards Models
Retrospective Studies
Risk factors
Sex Factors
Abstract
Uncontrolled hypertension is associated with an increased risk of end-stage renal disease (ESRD). Intensified blood pressure control may slow progression of chronic kidney disease; however, the impact of antihypertensive agent adherence on the prevention of ESRD has never been evaluated. Here we assessed the impact of antihypertensive agent adherence on the risk of ESRD in 185,476 patients in the RAMQ databases age 45 to 85 and newly diagnosed/treated for hypertension between 1999 and 2007. A case cohort study design was used to assess the risk of and multivariate Cox proportional models were used to estimate the adjusted hazard ratio of ESRD. Adherence level was reported as a medication possession ratio. Mean patient age was 63 years, 42.2% male, 14.0% diabetic, 30.3% dyslipidemic, and mean follow-up was 5.1 years. A high adherence level of 80% or more to antihypertensive agent(s) compared to a lower one was related to a risk reduction of ESRD (hazard ratio 0.67; 95% confidence intervals 0.54-0.83). Sensitivity analysis revealed that the effect is mainly in those without chronic kidney disease. Risk factors for ESRD were male, diabetes, peripheral artery disease, chronic heart failure, gout, previous chronic kidney disease, and use of more than one agent. Thus, our study suggests that a better adherence to antihypertensive agents is related to a risk reduction of ESRD and this adherence needs to be improved to optimize benefits.
PubMed ID
23698228 View in PubMed
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Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature162000
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Publication Type
Article
Date
Aug-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St (Ste 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - economics - therapeutic use
Aged
Aged, 80 and over
British Columbia
Case-Control Studies
Cohort Studies
Comorbidity
Cost Sharing
Deductibles and Coinsurance
Diabetes Complications
Female
Health Policy - trends
Humans
Male
Medical Record Linkage
Myocardial Infarction - drug therapy - economics
Patient Compliance - statistics & numerical data
Prescription Fees
Vascular Diseases
Abstract
To evaluate the effects of patient copayment and coinsurance policies on adherence to therapy with beta-adrenergic blocking agents (beta-blockers) and on the rate of initiation of beta-blocker therapy after acute myocardial infarction (MI) in a population-based natural experiment.
Three sequential cohorts included British Columbia residents age 66 years and older who initiated beta-blocker therapy during time intervals with full drug coverage (2001), a $10 or $25 copayment (2002), and 25% coinsurance (2003-2004). We used linked data on all prescription drug dispensings, physician services, and hospitalizations. Follow-up of each cohort was 9 months after the policy changes.
We measured the proportion of subjects in each cohort who were adherent to beta-blocker therapy over time, with adherence defined as having >80% of days covered. We also measured the proportion of patients initiating beta-blocker therapy after acute MI. Policy effects were evaluated using multivariable regression.
Adherence to beta-blocker therapy was marginally reduced as a consequence of the copayment policy (-1.3 percentage points, 95% confidence interval [CI] = -2.5 , -0.04) or the coinsurance policy (-0.8 percentage points, 95% CI = -2.0, 0.3). The proportion of patients initiating beta-blockers after hospitalization for acute MI remained steady at about 61% during the study period, similar to that observed in a control population of elderly Pennsylvania residents with full drug coverage.
Fixed patient copayment and coinsurance policies had little negative effect on adherence to relatively inexpensive beta-blocker therapy, or initiation of beta-blockers after acute MI.
Notes
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PubMed ID
17685825 View in PubMed
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