Medication Non-Compliance as a Determinant of Stroke Severity and Mortality in Diabetic and Hypertensive Patients
Article Sidebar
Main Article Content
Abstract
Introduction: Hypertension and diabetes mellitus are major modifiable risk factors for stroke, but the impact of medication adherence on stroke severity and short-term outcomes remains underexplored. This study evaluated the association between treatment compliance, stroke severity, and in-hospital mortality.
Methods: In this prospective observational study, 115 adult patients with radiologically confirmed stroke and documented diabetes or hypertension were enrolled. Medication adherence over the preceding three months was assessed (≥80% defined as compliant), and stroke severity was graded using the NIHSS.
Results: Non-compliant patients in both diabetic and hypertensive groups presented with significantly more severe strokes (p < 0.01). Mortality occurred exclusively in non-compliant diabetics (26.3%) and was significantly higher in non-compliant hypertensives (10.7%).
Conclusion: Medication non-compliance is strongly associated with increased stroke severity and higher in-hospital mortality, highlighting adherence as a critical and modifiable determinant of stroke outcomes.
Metrics
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
All open access articles published in the journal are distributed under the terms of the CC-BY-NC-SA 4.0 license (Creative Commons Attribution-Non-commercial-ShareAlike 4.0 International License) which permits unrestricted use, distribution, and reproduction in any medium, for non-commercial purposes, provided the original work is properly cited and distributed under the same license (ShareAlike). Under Creative Commons, authors retain copyright in their articles.
References
O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The lancet. 2016 Aug 20;388(10046):761-75.
Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G, Mancia G. Better compliance to antihypertensive medications reduces cardiovascular risk. Journal of hypertension. 2011 Mar 1;29(3):610-8.
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. Circulation. 2009 Oct 20;120(16):1598-605.
Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, Magid DJ. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Archives of internal medicine. 2006 Sep 25;166(17):1836-41.
Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. Jama. 2007 Jan 10;297(2):177-86.
Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, Stricker B, Mendis S, Hofman A, Mant J, Franco OH. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European heart journal. 2013 Oct 7;34(38):2940-8.
Mani UA, Ansari D, Bhot FB, Sada E, Ursekar R. Auto-amputation of an Entire Foot with Ankle in a Diabetic Patient. Advanced Journal of Emergency Medicine. 2019 Aug 17;3(4):e47.
Bhandare SS, Roy S, Mani UA, Gautam K. Ophthalmological and radiological findings in patients of hypertensive crisis reporting to an intensive care setting. Heart India 2023;11:109‑12.
Adake D, Mani UA, Sada E, Shriyan S, Sarangan V, Ursekar R, Singh P. Incidence of Ventricular Fibrillation in Patients presenting with Myocardial Infarction. Hypertension Journal. 2023 Dec 28;9(4):16-7.
Adake D, Singh P, Mani UA, Ursekar R, Sada E, Bhot F, Shriyan SV, Sarangan V. A Clinical Overview of Patients Presenting to ER with Myocardial Infarction Assessed by ESI. National Journal of Emergency Medicine. 2023;1(2):48-51.
Kumar M, Mani UA, Abbas H, Gupta P. High-Intensity Statins in Acute Coronary Syndrome Part I: A look at the Pharmacological Properties of Statins and Clinical Trials on Statins in ACS. Hypertension Journal. 2023; 9(2): 6-13.
Gupta P, Mani UA, Kumar M, Abbas H. High Intensity Statins in Acute Coronary Syndrome Part 2: A comparison of Atorvastatin and Rosuvastatin for use in ACS, Clinical trials in India and Place for statins in current guidelines. Hypertension Journal. 2023; 9(2): 14-19.
Mathur P, Huliyappa D, Pv P, Urs V, Koli RR, N S, Seenappa K, National Stroke Registry Programme (NSRP) Investigators. Stroke Patterns, Risk factors, Management and Outcomes from Hospital Based Stroke Registries in India. International Journal of Stroke.:17474930251393187.
Singh SK, Semwal J, Shikha D, Singh Y, Bansal D, Bhattacharya S. Diabetes mellitus as a risk factor for ischemic stroke: a case control study. Int J Community Med Public Heal. 2019 Mar 27;6(4):1554.
Shree S, Jatav J, Gupta R. Study the correlation of glycosylated haemoglobin (Hba1c) with severity of ischemic stroke in patients with diabetes mellitus vs non-diabetics. Indian Journal of Endocrinology & Metabolism. 2022 Dec 2;26.
Mani UA, Kumar M, Abbas H, Gupta P, Abbas H, Alam J, Alam S, Akram Y, Raza SH. Inhospital Ischemic Stroke with Typical and Atypical Risk Factors. Journal of The Association of Physicians of India. 2025 Feb;73(2):e10.
Mani UA, Ghatak T, Sriramula N, Singh P, Yadav AR, Kumar M. Artificial Intelligence and Early Detection of Diabetic-Hypertensive Emergencies in the Emergency Room. Hypertension Journal. 2025;11(3):67–72.
Adake D, Mani UA, Sarangan V, Shriyan S, Sada E, Bhot FB, Ursekar R, Singh P. Prevalence of Hepatitis B, Hepatitis C and HIV in Patients Presenting with Myocardial Infarction to Emergency Department. Indian Journal of Communicable Diseases/Volume. 2023 Jul;9(2).
Mani UA, Gautam K. Anti-Hypertensive Properties of Himalayan Raspberries: A Case Series of Five Hypertensive Patients. Hypertension Journal. 2025;11(3):73–75.
Mani UA, Kumar M, Abbas H, Gupta P. Stroke rehabilitation and the role of AI tools in physical recovery. Hypertension Journal. 2021;7(3):153-7.
Tiwari R, Verma S, Verma N, Singh S, Yadav S, Nishat N, Mittal A. Navigating the Intersection of Hypertension and Erectile Dysfunction: Advances in Diagnosis, Treatment, and Lifestyle Management. Hypertension Journal. 2023 May 30;9(1):10-4.
Verma S, Verma A, Kanodia N, Srivastava S, Ansari S, Tewari A, Maheswari A, Srivastava M. Exploring the Synergy Between Hyperuricemia, Obesity, and Hypertension: Evidence from Urban India. Hypertension Journal. 2024 Apr 25;10(1):13-8.
Tiwari R, Verma S, Verma N, Verma D, Narayan J. Correlation of serum uric acid levels with certain anthropometric parameters in prediabetic and drug-naive diabetic subjects. Annals of African Medicine. 2024 Jan 1;23(1):13-8.
Verma S, Tiwari R, Verma N, Singh S, Sharma A. Anthropometry and blood biomarkers of diabetes and their possible association with obesity and metabolic syndrome. Journal of Diabetes & Metabolic Disorders. 2024 Jun;23(1):509-17.
Tiwari R, Singh N, Singh S, Bajpai M, Verma S, Singh Sr N. Interplay of adiponectin with glycemic and metabolic risk metrics in patients with diabetes. Cureus. 2024 Sep 30;16(9).
Tiwari R, Singh S, Bajpai M, Verma N, Verma S. Impact of Osteocalcin on Glycemic Regulation and Insulin Sensitivity in Type 2 Diabetes Mellitus Patients. Cureus. 2024 Oct 17;16(10).