title: Management of antihypertensive drugs in three European countries.
abstract: OBJECTIVE
  To compare rates of treatment discontinuation of and changes in initial antihypertensive drug therapy in the natural setting of treatment dispensation of Italy, Sweden and the Netherlands.
  
  
  METHODS
  The cohorts included all the 23 715 (Italy), 20 289 (Sweden), and 5801 (the Netherlands) patients aged 40-70 years who received their first antihypertensive drug prescription from July 1, 2006 to September 30, 2006. Discontinuation was assumed if no antihypertensive drug was issued within 90 days following the end of the latest antihypertensive dispensation. Addition or replacement of the initial medication during the 90-day interval were defined as treatment combination or treatment switching.
  
  
  RESULTS
  At 9 months after treatment initiation, the discontinuation rate of any antihypertensive drug was 24%. Compared with Italian patients, the discontinuation rate was significantly lower in Swedish [hazard ratios: 0.52, 95% confidence interval (CI): 0.50-0.54] and Dutch patients (hazard ratio: 0.79, 95% CI: 0.75-0.84). Almost 21 and 16% of patients who started on monotherapy respectively combined with and switched to another antihypertensive drug. Compared with Italian patients, the adjusted hazard rate of combining was lower in Swedish patients (hazard ratio: 0.83, 95% CI: 0.79-0.87). The hazard rate of switching was lower in Swedish and Dutch patients than in Italians (hazard ratios: 0.83, 95% CI: 0.79-0.88 and hazard ratio: 0.77, 95% CI: 0.71-0.84 respectively).
  
  
  CONCLUSIONS
  Management of hypertension is unsatisfactory worldwide due to a very high rate of treatment discontinuation or insufficient use of proper treatment strategies.
authors.affiliation: Department of Statistics, University of Milano-Bicocca, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Nicotra
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Rino
authors.initials: R
authors.lastname: Bellocco
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Andrejs
authors.initials: A
authors.lastname: Leimanis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Michael
authors.initials: M
authors.lastname: Fored
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D013548:Sweden; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents