• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of cmajCMAJ Information for AuthorsCMAJ Home Page
CMAJ. Jan 12, 1999; 160(1): 31–37.
PMCID: PMC1229943

Persistence with treatment for hypertension in actual practice


BACKGROUND: Despite the existence of efficacious medications, many patients in actual practice remain with uncontrolled hypertension. Randomized clinical trials, cannot address this issue well given their highly restricted environment. This paper examines persistence with antihypertensive therapy among patients in actual practice. METHODS: Cohort study of patients who received a diagnosis of hypertension and were treated between 1989 and 1994 identified through the Saskatchewan Health databases. Patients with concurrent diagnoses likely to affect initial treatment choice were excluded. The resulting population of 79,591 subjects was grouped into those with established hypertension (52,227 [66%]) and those with newly diagnosed hypertension (27,364 [34%]). The initial antihypertensive prescription, subsequent changes in treatment and persistence with antihypertensive therapy were analysed. RESULTS: Persistence with antihypertensive therapy decreased in the first 6 months after treatment was started and continued to decline over the next 4 years. Of the patients with newly diagnosed hypertension, only 78% persisted with therapy at the end of 1 year, as compared with 97% of the patients with established hypertension (p < 0.001). Among those with newly diagnosed hypertension, older patients were more likely than younger ones to persist, and women were more likely than men to persist (p < 0.001). INTERPRETATION: This analysis of actual practice data indicates that barriers to persistence occur early in the therapeutic course and that achieving successful therapy when treatment is started is important to maintaining long-term persistence.

Full Text

The Full Text of this article is available as a PDF (246K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA. 1996 May 22;275(20):1571–1576. [PubMed]
  • Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22;275(20):1557–1562. [PubMed]
  • Moser M. Historical perspective on the management of hypertension. Am J Med. 1986 May 23;80(5B):1–11. [PubMed]
  • Gueyffier F, Froment A, Gouton M. New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit. J Hum Hypertens. 1996 Jan;10(1):1–8. [PubMed]
  • Neaton JD, Grimm RH, Jr, Prineas RJ, Stamler J, Grandits GA, Elmer PJ, Cutler JA, Flack JM, Schoenberger JA, McDonald R, et al. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993 Aug 11;270(6):713–724. [PubMed]
  • Stockwell DH, Madhavan S, Cohen H, Gibson G, Alderman MH. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994 Nov;84(11):1768–1774. [PMC free article] [PubMed]
  • Mancia G, Sega R, Milesi C, Cesana G, Zanchetti A. Blood-pressure control in the hypertensive population. Lancet. 1997 Feb 15;349(9050):454–457. [PubMed]
  • Joffres MR, Hamet P, Rabkin SW, Gelskey D, Hogan K, Fodor G. Prevalence, control and awareness of high blood pressure among Canadian adults. Canadian Heart Health Surveys Research Group. CMAJ. 1992 Jun 1;146(11):1997–2005. [PMC free article] [PubMed]
  • Hershey JC, Morton BG, Davis JB, Reichgott MJ. Patient compliance with antihypertensive medication. Am J Public Health. 1980 Oct;70(10):1081–1089. [PMC free article] [PubMed]
  • Pablos-Méndez A, Barr RG, Shea S. Run-in periods in randomized trials: implications for the application of results in clinical practice. JAMA. 1998 Jan 21;279(3):222–225. [PubMed]
  • Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ. 1995 Jul 29;311(7000):293–295. [PMC free article] [PubMed]
  • Hamilton RA, Briceland LL. Use of prescription-refill records to assess patient compliance. Am J Hosp Pharm. 1992 Jul;49(7):1691–1696. [PubMed]
  • Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Correlates of nonadherence to hypertension treatment in an inner-city minority population. Am J Public Health. 1992 Dec;82(12):1607–1612. [PMC free article] [PubMed]
  • Sharkness CM, Snow DA. The patient's view of hypertension and compliance. Am J Prev Med. 1992 May-Jun;8(3):141–146. [PubMed]
  • Cooper JK, Love DW, Raffoul PR. Intentional prescription nonadherence (noncompliance) by the elderly. J Am Geriatr Soc. 1982 May;30(5):329–333. [PubMed]
  • Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens. 1997 Jul;10(7 Pt 1):697–704. [PubMed]
  • Okano GJ, Rascati KL, Wilson JP, Remund DD, Grabenstein JD, Brixner DI. Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker. Clin Ther. 1997 Nov-Dec;19(6):1433–1425. [PubMed]
  • McAlister FA, Teo KK, Lewanczuk RZ, Wells G, Montague TJ. Contemporary practice patterns in the management of newly diagnosed hypertension. CMAJ. 1997 Jul 1;157(1):23–30. [PMC free article] [PubMed]
  • Tennis P, Bombardier C, Malcolm E, Downey W. Validity of rheumatoid arthritis diagnoses listed in the Saskatchewan Hospital Separations Database. J Clin Epidemiol. 1993 Jul;46(7):675–683. [PubMed]
  • Rawson NS, Malcolm E. Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles. Stat Med. 1995 Dec 30;14(24):2627–2643. [PubMed]
  • Rawson NS, Malcolm E, D'Arcy C. Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles. Soc Psychiatry Psychiatr Epidemiol. 1997 May;32(4):191–199. [PubMed]
  • Reeves RA. The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. JAMA. 1995 Apr 19;273(15):1211–1218. [PubMed]
  • Pierdomenico SD, Mezzetti A, Lapenna D, Guglielmi MD, Mancini M, Salvatore L, Antidormi T, Costantini F, Cuccurullo F. 'White-coat' hypertension in patients with newly diagnosed hypertension: evaluation of prevalence by ambulatory monitoring and impact on cost of health care. Eur Heart J. 1995 May;16(5):692–697. [PubMed]

Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...