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J Hypertens. 2005 Nov;23(11):2101-7.

Rate and determinants of 10-year persistence with antihypertensive drugs.

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  • 1Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, The Netherlands.

Abstract

OBJECTIVE:

To assess the proportion of patients starting with antihypertensive drug treatment who continued treatment for at least 10 years.

DESIGN:

A retrospective cohort study.

SETTING:

The PHARMO record linkage system containing drug dispensing records from community pharmacies and linked hospital discharge records of approximately 950 000 subjects.

PARTICIPANTS:

Patients who started using antihypertensive drugs (two or more prescriptions) in 1992 and did not receive a prescription for any antihypertensive drug in the 365 days preceding the first prescription.

MAIN OUTCOME MEASURE:

Persistence with antihypertensive drugs until 10 years.

RESULTS:

Among a total of 2325 patients who started using antihypertensive drugs, 39% used continuously during the 10 years of follow-up. Approximately 22% temporarily discontinued and restarted treatment, whereas 39% of patients discontinued permanently. Older patients were more persistent than younger patients [20-39 years: odds ratio (OR) 2.08; 95% confidence interval (CI) 1.52-2.84; 40-59 years: (reference), > or = 60 years: OR 0.69; 95% CI 0.54-0.89]. More patients who started with diuretics (reference) and beta blockers (OR 1.15; 95% CI 0.87-1.52) discontinued compared with those who started with dihydropyridine calcium antagonists (OR 0.54; 95% CI 0.34-0.84), and angiotensin-converting enzyme (ACE) inhibitors (OR 0.38; 95% CI 0.27-0.55). Patients who started with combination therapy (OR 0.29; 95% CI 0.14-0.54 compared with diuretics) or patients who were initially treated by a cardiologist (OR 0.82; 95% CI 0.61-0.97) or internist (OR 0.80; 95% CI 0.62-0.98 compared with general practitioners) also showed higher persistence.

CONCLUSION:

Long-term persistence in daily practice is low compared with persistence observed in randomized clinical trials and should be considered in the choice of a first-line antihypertensive agent.

PMID:
16208154
[PubMed - indexed for MEDLINE]
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