Antihypertensive Therapy Initiation Associated With Lifestyle Changes

Initiation of antihypertensive or statin therapy was found to be associated with both positive and negative lifestyle changes, according to a study published in the Journal of the American Heart Association.

In this longitudinal cohort study, repeat observational data were examined to evaluate the effect of antihypertensive or statin therapy initiation on lifestyle. Study participants were ≥40 years, free of cardiovascular disease at baseline, and were employees in the Finnish public sector (n=81,772). Participants completed ≥2 surveys (waves 1 and 2). Records of pharmacy claims were used to assess medication use. Initiators were defined as participants who filled ≥1 preventive medication prescription for the first time between the baseline and the wave 2 response dates (n=8837). Noninitiators were defined as participants with no prescription fills by wave 2 (n=46,021). Changes in body mass index (BMI), physical activity, alcohol consumption, and smoking were compared in pre-post data sets.

The mean BMI increased for both initiators and noninitiators, but the difference was greater in initiators in the fully adjusted model (difference, 0.19; 95% CI, 0.16-0.22). Physical activity declined in patients who initiated vs did not initiate therapy (difference, -0.09 in metabolic equivalent of task [MET] hours/day; 95% CI, -0.16 to -0.02). Average weekly alcohol consumption was reduced to a greater extent in initiators vs noninitiators (-1.85 g/week; 95% CI, -3.67 to -0.14). Statin initiation was more strongly associated with a decline in average weekly alcohol consumption (-2.38 g; 95% CI, -4.33 to -0.43) and quitting smoking (odds ratio [OR], 0.63; 95% CI, 0.53-0.75). Initiators vs noninititators who were baseline smokers were more likely to quit smoking (adjusted OR, 0.74; 95% CI, 0.64-0.85).

Study limitations include a relatively homogenous sample (white public-sector workers), the lack of information on professional counseling on recommended lifestyle changes, or on diet, blood pressure, or cholesterol levels. “Our findings support the notion that there is scope to improve management of lifestyle-related risk factors among individuals who have initiated preventive medication. Patients’ awareness of their risk factors alone seems not to be effective in improving health behaviors,” the researchers concluded. “Expansion of pharmacologic interventions toward populations at low [cardiovascular] risk may not necessarily lead to expected benefits at the population level. More effective measures are needed to support the recommended lifestyle change in relation to the initiation of pharmacologic interventions for primary prevention.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

Reference

Korhonen MJ, Pentti J, Hartikainen J, et al. Lifestyle changes in relation to initiation of antihypertensive and lipid-lowering medication: a cohort study. [published online February 5, 2020]. J Am Heart Assoc. doi:10.1161/JAHA.119.014168