THE IMPACT OF ADHERENCE ON THE PREVALENCE OF THE SPRINT ELIGIBLE SUBJECTS IN KOREAN NATIONAL HEALTH INSURANCE SERVICE - NATIONAL SAMPLE COHORT (NHIS-NSC)

Abstract

Objective: Systolic Blood Pressure Intervention Trial (SPRINT) provided the evidence for additional blood pressure (BP) reduction but due to the extensive exclusion criteria, the clinical applicability has been challenged. Moreover, the applicability to Asian ethnicity remains to be clarified. This study is to identify the prevalence of SPRINT eligible population using Korean National Health Insurance Service – National Sample Cohort (NHIS-NSC).

Design and method: Among 205333 subjects aged 30 or more, 55847 subject with systolic BP > 140 mmHg or taking AHM at least 300 days recently opened Korean National Health Insurance Service – National Sample Cohort (NHIS-NSC) 2010 data, by applying exclusion criteria such as eGFR < 20 ml/min/1.72m2 (n = 869), proteinuria > 3+ (n = 261), diabetes (n = 10601), and stroke history (n = 799), 43317 subjects were analyzed for the calculation of 10 year cardiovascular risk, Korean Hypertension Society Hypertension (KoSH) guideline risk stratification system. For KoSH scoring system, 4348 subjects were analyzed for Framingham risk score system. Anti-hypertension medication (AHM) status was defined as adherence > 80%.

Results: Age was 57.3 ± 12.1 and female was 43.3%. BPs were 136.5 ± 15.6/85.1 ± 10.9 mmHg. Fasting blood glucose was 96.5 ± 11.8 mg/dL. The number of CV risk factor and clinical CV disease were 2.1 ± 0.9 and 2.4%. When the pill count based on adherence > 80% for each drug and when applying KoSH scoring system, excluding 12102 subjects aged below 50, 18180 subjects with 10 year CV risk < 15%, and 4217 subjects with systolic BP < 130 mmHg, 8833 subjects (15.8%) were eligible for SPRINT protocol.

Conclusions: The applicability of the SPRINT study can be differently assessed mainly by the locally adopted scoring system to define high risk subgroup. Moreover the adherence criteria could markedly affect the prevalence of eligible population.