Choices, persistence and adherence to antihypertensive agents: evidence from RAMQ data.
BACKGROUND
Most treatment recommendations for hypertension are based on criteria that consider efficacy, safety and cost. Given the need for long-term use of antihypertensive agents, treatment compliance should also be taken into consideration in the selection process.


OBJECTIVE
The purpose of the present study was to estimate persistence and adherence to antihypertensive agents in a real-life setting.


METHODS
Persistence and adherence to treatment were estimated using data from the Regie de l'assurance maladie du Quebec.


RESULTS
Data from a random sample of 4561 subjects with a diagnosis of hypertension covered by the Regie de l'assurance maladie du Quebec drug plan and using one of the antihypertensive agents reimbursed by the drug plan for the first time between January 2000 and December 2001 were analyzed. The persistence rate observed after a two-year period with diuretics was significantly lower (52.8%) than with any other classes of antihypertensive agent (P<0.01). Persistence rates for beta-blockers, calcium channel blockers, angiotensin-II receptor blockers and angiotensin-I converting enzyme inhibitors were 69.3%, 64.3%, 60.9% and 58.9%, respectively. After two years, the proportion of patients who were 80% adherent to their treatment was 64.9% for angiotensin-I converting enzyme inhibitors, 65.0% for angiotensin-II receptor blockers, 64.2% for calcium channel blockers, 60.3% for beta-blockers and 50.9% for diuretics. The proportion of patients who were 80% adherent to their treatment was significantly lower for diuretics than with any other antihypertensive agents (P<0.01).


CONCLUSIONS
Persistence and adherence to treatment are essential to treatment success. Results of the present study indicate that, in a real-life setting, patients are significantly less compliant to diuretics than to any other antihypertensive agents.
Lachaine
Jean
J
Faculty of Pharmacy, University of Montreal, Montreal, Quebec. jean.lachaine@umontreal.ca
Petrella
Robert J
RJ
Merikle
Elizabeth
E
Ali
Farzad
F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D011792:Quebec
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics