Suboptimal medication adherence was associated with a significantly increased risk of mild cognitive impairment (HR 1.62), with blood pressure and blood pressure variability acting as partial mediators.
Observational (n=7,371)
Does suboptimal antihypertensive medication adherence increase the risk of mild cognitive impairment in adults?
Suboptimal antihypertensive medication adherence is a modifiable risk factor associated with increased risk of mild cognitive impairment, partially mediated by average blood pressure and blood pressure variability.
Effect estimate: HR 1.62
p-value: p=0.00004
Objectives/Goals: The objective of this research is to investigate the association between suboptimal self-reported antihypertensive medication adherence, increased blood pressure variability (BPV), and cognitive decline independent of average blood pressure (BP) levels in a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Methods/Study Population: 7371 participants with medication adherence, blood pressure, and mild cognitive impairment follow-up data were included for analysis (36% female, mean age 68.3±9.22). BPV was calculated as the standard deviation of available systolic blood pressure measurements. Medication adherence was quantified using the “Percent Meds” variable, a self-report measure that quantifies the proportion of the last 10 days that a participant remembered to take their medications correctly. Suboptimal medication adherence was defined as 90% adherence or less. Survival analysis using Cox proportional hazards regression was used to assess the mediating effects of BPV and BP on the association between suboptimal medication adherence and increased MCI risk. Results/Anticipated Results: Proportional hazards regression showed suboptimal medication adherence to be associated with increased MCI risk (HR=1.62, P=.00004). Both systolic BP (HR: 1.14, P=.002) and systolic BPV (HR: 1.11, P=.004) displayed independent adverse effects on MCI risk. In parallel mediation, BPV (indirect effect log hazard=.01, 95%CI=.002-.02) and BP (indirect effect log hazard=.009, 95%CI=.001-.02) acted as partial mediators of the association between suboptimal medication adherence and increased MCI risk. All models were adjusted for age, sex, resting heart rate, and history of cardiovascular and chronic kidney disease. Discussion/Significance of Impact: Average BP and BPV are independently associated with increased MCI risk and represent distinct risk factors for MCI conversion. Both average pressure and variability in pressure link suboptimal medication adherence to increased MCI risk, suggesting that suboptimal medication adherence is a modifiable risk factor for MCI conversion.
Lohman et al. (Wed,) conducted a observational in Mild cognitive impairment (n=7,371). Suboptimal medication adherence (≤90% adherence) vs. Optimal medication adherence (>90% adherence) was evaluated on Mild cognitive impairment risk (HR 1.62, p=0.00004). Suboptimal medication adherence was associated with a significantly increased risk of mild cognitive impairment (HR 1.62), with blood pressure and blood pressure variability acting as partial mediators.