Increase risk of hospitalization for cardiovascular disease among hypertensive patients not-adhering to treatment guideline : A national-wide study

Introduction:Hypertension is a major risk factor for cardiovascular diseases (CVD) which are common causes of mortality in Taiwan. Little is known about the effectiveness of treatment guideline in treating hypertensive patients in Taiwan.Materials and Method:

The information on hypertensive patients who had beed treated at least one year on the participated practice site was obtained from the records system of a disease management program implemented by Bureau of National Health Insurance in 2006. We examined the NHI clinical database from 2005 to 2006 to identify all claims of outpatients for antihypertensive drugs. Subjects were stratified into one or more than one practice site for treatment of hypertension. The risk of hospitalization for CVD was examined using multivariable logistic regression models.

Results:116,033 hypertensive patients were identified in disease management program and 7,191 of them were excluded for having inpatient encounters of CVD in 2005. Therefore, a total of 108,842 patients were included in the study. Fifty three percent of these patients were treated by the same clinic following disease management guideline. Unadjusted associations with the risk of hospitalization for CVD included age,female,smoke,obesity, diabetes, hyperlipidemia and seeing more than one doctor. After controlling for these variables, patients treated with antihypertensive drugs from more than one practice sites were a significant increase in the risk of CVD events (OR=3.37 95%CI:3.18-3.57).Conclusion:Patients with hypertension who do doctor shopping increases the risk of hospitalization due to CVD, because of bad blood pressure control or potential drug-drug interactions. The results show the strong need for increasing patient knowledge about hypertension, including adherence treatment and side effects of antihypertensive medication.