Persistence with antihypertensive treatments: results of a 3-year follow-up cohort study.
OBJECTIVE
Effective treatment of hypertension requires continued prescribing of antihypertensive medications for many years. Persistence in prescribing habits, however, has been reported to be low. The study described herein - which is completely independent of pharmaceutical sponsors - was undertaken to evaluate persistence with antihypertensive treatment in Germany.


METHODS
A total of 13,763 newly diagnosed hypertensive patients were identified in the IMS Disease Analyzer database and observed for 3 years after their first antihypertensive prescription.


RESULTS
The median age of the study cohort was 65 years, and 56% were female. One in four patient received no more than three prescriptions within 3 years. Persistence was longest for patients whose initial prescription was for a free combination based on angiotensin converting enzyme inhibitors (median: 392.5 days), followed patients initially receiving a fixed combination, including angiotensin II receptor antagonists (208.5 days) and AIIRA monotherapy (168 days). Persistence was shortest with diuretics (57 days). Across all treatment groups, persistence after 3 years was 15.2%. Insurance status, sex and comorbidities were not found to impact persistence.


CONCLUSIONS
Our data indicate that persistence differs markedly among the drug classes (p < or = 0.001) but that even persistence of the best drug class is not sufficient to provide for an adequate blood pressure control in the population. The largest decline in persistence occurred in the first 3 months of treatment. More research is needed to elucidate the causes of this early drop in persistence and to develop effective means of improving the currently unsatisfactory situation.
Hasford
Joerg
J
IBE - Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany. has@ibe.med.uni-muenchen.de
Schröder-Bernhardi
Detlef
D
Rottenkolber
Marietta
M
Kostev
Karel
K
Dietlein
Gerhard
G
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004338:Drug Combinations
JAMA. 2003 May 14;289(18):2363-9
12746359
Am J Manag Care. 2005 Nov;11(13 Suppl):S395-9
16300455
Ann Pharmacother. 1995 Dec;29(12):1213-17
8672823
BMC Med. 2005 Jan 05;3:2
15629061
Manag Care. 2003 Aug;12(8 Suppl Hypertension):56-61
12971594
J Clin Hypertens (Greenwich). 2003 Mar-Apr;5(2):127-32
12671325
Int J Clin Pharmacol Ther. 2002 Mar;40(3):130-3
11911603
J Hypertens. 2005 Nov;23(11):2093-100
16208153
Cochrane Database Syst Rev. 2004;(2):CD004804
15106262
J Hypertens. 2004 Oct;22(10):1849-55
15361751
CMAJ. 1999 Jan 12;160(1):41-6
9934342
Arch Intern Med. 1997 Nov 24;157(21):2413-46
9385294
JAMA. 2002 Dec 18;288(23):2981-97
12479763
N Engl J Med. 2005 Aug 4;353(5):487-97
16079372
Ann Pharmacother. 2005 Sep;39(9):1401-8
16076920
Curr Opin Cardiol. 2005 Jul;20(4):296-300
15956826
Eur J Clin Pharmacol. 2004 Apr;60(2):135-42
15042351
Eur J Clin Pharmacol. 2005 Sep;61(8):603-9
16082539
Can J Clin Pharmacol. 2004 Fall;11(2):e267-73
15596883
Pharmacoepidemiol Drug Saf. 2005 Nov;14(11):795-803
16178043
J Clin Epidemiol. 2006 Jan;59(1):11-7
16360556
Manag Care. 2001 Feb;10(2):42-5
11236643
Herz. 2004 May;29(3):271-5
15167953
J Hum Hypertens. 2002 Aug;16(8):569-75
12149663
Manag Care. 2000 Sep;9(9 Suppl):2-6
11729417
BMJ. 1995 Jul 29;311(7000):293-5
7633238