Trial reportHypertension research : official journal of the Japanese Society of Hypertension2026
Fluctuations in adherence to antihypertensive medication and cardiovascular outcomes: a secondary analysis of the SPRINT trial.
Trial report in Hypertension research : official journal of the Japanese Society of Hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01206062 (Systolic Blood Pressure Intervention Trial), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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Systolic Blood Pressure Intervention Trial
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Abstract
backgroundNon-adherence to antihypertensive regimens undermines both hypertension therapy and the validity of clinical trials. However, existing adherence measures do not effectively reflect bidirectional medication-taking behavior. This secondary SPRINT analysis investigated at how dynamic, bidirectional adherence to medication patterns associated with cardiovascular outcomes.
methodsWe analyzed self-reported medication information for 9343 participants. Adherence was divided into four categorized based on discrepancies between prescribed and taken medication over the first 12 months: full adherence, over-adherence, under-adherence, and fluctuating adherence. The primary outcomes were composite cardiovascular events and all-cause mortality; the secondary outcomes were 12-month systolic blood pressure (SBP) control, SBP variability from visit to visit (coefficient of variance), and serious adverse events (SAEs).
resultsOver a median follow-up of 3.26 years, 53.6% displayed full adherence, while 16.2%, 22.7%, and 7.5% showed over-, under-, and fluctuating adherence. Compared to full adherence, fluctuating adherence was independently associated with significantly elevated risks of composite cardiovascular events (HR: 1.737, 95% CI: 1.250-2.414, P﹤0.001) and all-cause mortality (HR: 1.487, 95% CI: 1.030-2.147, P = 0.029). This pattern was also associated with decreased SBP control (OR: 0.825, 95% CI: 0.700-0.972, P = 0.022), increased SBP variability, and the highest incidence of SAEs in non-adherence groups. There were no significant changes in outcomes between over- or under-adherence and full adherence. Importantly, the detrimental association for fluctuating adherence persisted among a subgroup of patients classified as "fully adherent" by the self-reported Visual Analog Scale.
conclusionsFluctuating antihypertensive adherence, characterized by unstable use of medications, was independently linked with poor SBP control increased cardiovascular risk and mortality. Hypertension studies and clinical practice ought to prioritize identifying and managing dynamic adherence patterns to enhance trial validity and optimize the therapeutic benefits. Registration ClinicalTrials.gov (NCT01206062).
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