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000] until the beginning of 2004 [9.7 (8.1-11.6) per 10 000], after which a slight decre-
ase started, whereas the prevalence of use of typical antipsychotics decreased from 2001
[15.7 (13.5-18.2) per 10 000] until 2004 [10.7 (9.0-12.7) per 10 000], then slightly incre-
ased in December 2005 [12.1 (10.4-14.2) per 10 000]. Monthly trends in general popula-
tion and elderly were quite similar and differed significantly from the trend in elderly with
dementia: stable use of atypicals from 2002 to 2005 and strong reduction of typicals from
2001 to the end of 2004. The recent safety warnings led to an increasing trend in the use
of typical agents and decreasing trend in the use of atypical agents in elderly demented
outpatients in Italy. Similar trends were not observed in general population and elderly as
a whole.
Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, Borghi C, Brignoli
O, Caputi AP, Cricelli C, Mantovani LG. Adherence to antihypertensive medications
and cardiovascular morbidity among newly diagnosed hypertensive patients
. Cir-
culation. 2009;120:1598-605.
ABSTRACT. BACKGROUND: Nonadherence to antihypertensive treatment is a common
problem in cardiovascular prevention and may influence prognosis. We explored predic-
tors of adherence to antihypertensive treatment and the association of adherence with
acute cardiovascular events. METHODS AND RESULTS: Using data obtained from 400
Italian primary care physicians providing information to the Health Search/Thales Data-
base, we selected 18,806 newly diagnosed hypertensive patients >or=35 years of age
during the years 2000 to 2001. Subjects included were newly treated for hypertension
and initially free of cardiovascular diseases. Patient adherence was subdivided a priori
into 3 categories-high (proportion of days covered, >or=80%), intermediate (propor-
tion of days covered, 40% to 79%), and low (proportion of days covered, <or=40%)-
and compared with the long-term occurrence of acute cardiovascular events through
the use of multivariable models adjusted for demographic factors, comorbidities, and
concomitant drug use. At baseline (ie, 6 months after index diagnosis), 8.1%, 40.5%,
and 51.4% of patients were classified as having high, intermediate, and low adherence
levels, respectively. Multiple drug treatment (odds ratio, 1.62; 95% CI, 1.43 to 1.83),
dyslipidemia (odds ratio, 1.52; 95% CI, 1.24 to 1.87), diabetes mellitus (odds ratio,
1.40; 95% CI, 1.15 to 1.71), obesity (odds ratio, 1.50; 95% CI, 1.26 to 1.78), and
antihypertensive combination therapy (odds ratio, 1.29; 95% CI, 1.15 to 1.45) were
significantly (P<0.001) associated with high adherence to antihypertensive treatment.
Compared with their low-adherence counterparts, only high adherers reported a signi-
ficantly decreased risk of acute cardiovascular events (hazard ratio, 0.62; 95% CI, 0.40
to 0.96; P=0.032). CONCLUSIONS: The long-term reduction of acute cardiovascular
events associated with high adherence to antihypertensive treatment underscores its
importance in assessments of the beneficial effects of evidence-based therapies in the
population. An effort focused on early antihypertensive treatment initiation and adhe-
rence is likely to provide major benefits.
Avillach P, Mougin F, Joubert M, Thiessard F, Pariente A, Dufour JC, Trifirň G, Polime-
ni G, Catania MA, Giaquinto C, Mazzaglia G, Baio G, Herings R, Gini R, Hippisley-Cox
J, Molokhia M, Pedersen L, Fourrier-Réglat A, Sturkenboom M, Fieschi M. A semantic
approach for the homogeneous identification of events in eight patient data-
bases: a contribution to the European eu-ADR project
. Stud Health Technol Inform.
ABSTRACT. The overall objective of the eu-ADR project is the design, development,
and validation of a computerised system that exploits data from electronic health re-
cords and biomedical databases for the early detection of adverse drug reactions. Eight