Adherence to antihypertensive treatment was associated with a reduced risk of death among elderly patients, including frail individuals, according to a large study published in Hypertension.

The nested case-control study aimed to determine the relationship between adherence to antihypertensive therapy and the risk of death in frail versus nonfrail elderly patients. “We knew that high blood pressure medication was protective in general among older people, however, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomized trials,” said Giuseppe Mancia, MD, lead study author and professor emeritus at the University of Milano-Bicocca in Milan, Italy.

The study authors utilized the database of the Lombardy Region in Italy to identify 1,283,602 residents ≥65 years of age (mean: 76 years) who had at least 3 antihypertensive drug prescriptions between 2011 and 2012. Adherence, which was calculated by the proportion of the follow-up covered by prescriptions, was assessed for all patients based on clinical status (ie, good, medium, poor, very poor). Clinical status was measured using the Multisource Comorbidity Score, which  has been proven to be a sensitive predictor of death in the Italian population.

Findings of the study revealed that the probability of death over the 7-year follow-up period increased from 16% in the good clinical status group to 64% for patients who were considered to be in very poor health. “Compared with patients with very low adherence with antihypertensive treatment (<25% of follow-up time covered by prescriptions), those with high adherence (>75% of time covered by prescriptions) exhibited a lower risk of all-cause mortality in each group, the difference decreasing progressively (−44%, −43%, −40%, and −33%) from the good to the very poor clinical status,” the authors of the study reported. A similar pattern with adherence to antihypertensive therapy was also observed when analyzing cardiovascular deaths. 

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“Our findings definitely suggest that even in very frail people, antihypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group,” said Dr Mancia. 


Rea F, Cantarutti A, Merlino L, et al. Antihypertensive treatment in elderly frail patients [published online June 8, 2020]. Hypertension. doi: 10.1161/HYPERTENSIONAHA.120.14683.