title: Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice.
abstract: OBJECTIVE
  To measure persistence with antihypertensive drug therapy in patients initiating treatment with mono or combination therapy.
  
  
  METHODS
  Data analysis was based on two cohorts of patients, that is, a cohort derived from the registration of drug prescriptions in all residents of the Lombardy region receiving Public Health Service and a cohort of patients followed by general practitioners throughout the Italian territory. Data were limited to patients aged 40-80 years who received their first antihypertensive drug prescription (n = 433,680 and 41,199, respectively) in whom persistency of treatment was examined over 9 months. A proportional hazards model was fitted to estimate the association between the pattern of initial antihypertensive drug therapy and risk of treatment discontinuation. Data were adjusted for available potential confounders.
  
  
  RESULTS
  Taking patients starting with diuretic monotherapy as reference, the adjusted risk of treatment discontinuation was progressively lower in patients starting with monotherapy other than a diuretic, a two-drug combination, including a diuretic and a two-drug combination without a diuretic. No significant difference in the risk of discontinuation was seen between extemporaneous and fixed dose combinations, including a diuretic, that is, the only combination reimbursable by Public Health Service and, thus, available in the database. Data were similar for the two cohorts.
  
  
  CONCLUSIONS
  Initiating treatment with a combination of two drugs is associated with a reduced risk of treatment discontinuation.
authors.affiliation: Department of Statistics, Unit of Biostatistics and Epidemiology, University of Milano-Bicocca, Milan, Italy. giovanni.corrao@unimib.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Franca
authors.initials: F
authors.lastname: Heiman
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Claudio
authors.initials: C
authors.lastname: Cricelli
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D004232:Diuretics / Q000627:therapeutic use*; D004338:Drug Combinations; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D004338:Drug Combinations