title: Four-Year persistence patterns among patients initiating therapy with the angiotensin II receptor antagonist losartan versus other artihypertensive drug classes.
abstract: BACKGROUND
  It has been reported that a statistically greater percentage of patients initially treated with losartan, an angiotensin II receptor antagonist (AIIA), stayed on therapy at 1 year compared with patients treated with antihypertensive drugs from other classes.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether the stay-on-therapy (persistence) patterns observed in the previous analysis were maintained over a 4-year period.
  
  
  METHODS
  We investigated a subgroup of 15,175 hypertensive patients from an earlier studied cohort who were continuously eligible for benefits over a 4-year follow-up period. A linear regression model was developed to test the statistical significance of differences in the percentage of patients staying on therapy from 12 months to 48 months for the different antihypertensive classes.
  
  
  RESULTS
  From 12 to 48 months, there was a slow continuous decline in persistence that was similar across all classes of antihypertensive medications. A greater percentage of patients treated with an AIIA (losartan) stayed on therapy from 12 to 48 months compared with patients treated with angiotensin-converting enzyme inhibitors (67.4% vs 60.7% at 12 months, P < 0.01; 50.9% vs 46.5% at 48 months, P = 0.095), calcium antagonists (67.4% vs 54.1% at 12 months, P < 0.01; 50.9% vs 40.7% at 48 months, P < 0.03), beta-blockers (67.4% vs 45.6% at 12 months, P < 0.01; 50.9% vs 34.7% at 48 months, P < 0.03), or thiazide diuretics (67.4% vs 20.8% at 12 months, P < 0.01; 50.9% vs 16.4% at 48 months, P < 0.03). The percentage of patients staying on AIIA therapy from 12 months to 48 months was statistically greater (P < 0.001) than the percentage of patients staying on therapy with other antihypertensive drug classes.
  
  
  CONCLUSIONS
  This analysis supports the observation that initiation of antihylertensive therapy with an AIIA such as losartan results in a greater persistence rate over a 4-year period than does therapy with any other antihypertensive class. These findings may have important implications for blood pressure control, reduction of cardiovascular risks, and health care resource utilization.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: P R
authors.initials: PR
authors.lastname: Conlin
authors.forename: W C
authors.initials: WC
authors.lastname: Gerth
authors.forename: J
authors.initials: J
authors.lastname: Fox
authors.forename: J B
authors.initials: JB
authors.lastname: Roehm
authors.forename: S J
authors.initials: SJ
authors.lastname: Boccuzzi
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016014:Linear Models; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D019808:Losartan