High treatment adherence cuts risks of MACE, falls after stroke

Stroke survivors with high adherence to antihypertensive medications appear to have reduced risks of major adverse cardiovascular events (MACE) and falls requiring hospitalization, according to a study.

The retrospective cohort study used data from the Australian Stroke Clinical Registry (2012–2016; Queensland and Victoria) and included 4,076 patients (median age 68 years, 37 percent women) who were newly dispensed antihypertensive medications after an acute stroke.

Researchers looked at pharmaceutical dispensing records to assess medication adherence according to the proportion of days covered in the first 6 months after stroke. They evaluated MACE (a composite outcome of all-cause death, recurrent stroke, or acute coronary syndrome) and falls requiring hospitalization between 6 and 18 months after hospital discharge.

Of the patients, 58 percent had a proportion of days covered ≥80 percent within 6 months postdischarge. In the subsequent 12 months, 360 (9 percent) patients experienced a MACE and 337 (8 percent) had a fall requiring hospitalization.

Multivariable Cox regression analysis showed that patients with a proportion of days covered ≥80 percent had much lower risks of MACE (hazard ratio [HR], 0.68; 95 percent confidence interval [CI], 0.54–0.84) and falls requiring hospitalization (subdistribution HR, 0.78, 95 percent CI, 0.62–0.98) compared with those with a proportion of days covered <80 percent.

In light of the findings, stroke survivors should be encouraged to adhere to their antihypertensive medications to improve poststroke outcomes.