title: Implication of different initial beta blockers on treatment persistence: atenolol vs new-generation beta blocker, a population-based study.
abstract: OBJECTIVE
  Potential heterogeneity within the same class of drug in terms of persistence may lead to different clinical implications. Given that the increased risks of mortality and cardiovascular events are due, in part, to the lack of persistent use of antihypertensive medications, the objective of this study was to evaluate 1-year persistence of new-generation beta blockers compared to atenolol in antihypertensive treatment-naïve patients.
  
  
  METHODS
  A total of 9978 patients aged 18 years or older with hypertension newly diagnosed in 2012, without hypertension-related complication and initiated treatment with beta blocker monotherapy during 2012 were included in the analysis. Rate and duration of treatment and drug persistence were compared between atenolol and new-generation beta blockers. Hazards of discontinuation in nonatenolol compared to atenolol were evaluated using a multivariate Cox proportional model.
  
  
  RESULTS
  The rate of treatment persistence was higher in the nonatenolol group (57.35% vs 53.40%, P<.0001), and the time to treatment discontinuation was earlier in the atenolol group with a minimal difference in the average (243.2 vs 254 days, P<.0001). New-generation beta blockers demonstrated a lower risk of treatment discontinuation (HR: 0.91, 95% CI: 0.86-0.96) compared to atenolol; a notable improvement was observed with carvedilol and nebivolol (HR: 0.74, 95% CI: 0.69-0.80 and HR: 0.79, 95% CI: 0.70-0.89, respectively), whereas betaxolol showed a substantially greater hazard for discontinuation compared to atenolol.
  
  
  CONCLUSIONS
  This study demonstrated a meaningful improvement in treatment persistence with new-generation beta blockers compared to atenolol, with betaxolol as exception.
authors.affiliation: College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea.
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea.
authors.forename: Young-Mi
authors.initials: YM
authors.lastname: Ah
authors.affiliation: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
authors.forename: Jisun
authors.initials: J
authors.lastname: Kong
authors.affiliation: College of Pharmacy, Sunchon National University, Suncheon, Jeollanam-do, South Korea.
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Choi
authors.affiliation: College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea.
authors.forename: Baegeum
authors.initials: B
authors.lastname: Kim
authors.affiliation: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Han
authors.affiliation: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
authors.forename: Yun Mi
authors.initials: YM
authors.lastname: Yu
authors.affiliation: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
authors.forename: Jung Mi
authors.initials: JM
authors.lastname: Oh
authors.affiliation: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
authors.forename: Wan Gyoon
authors.initials: WG
authors.lastname: Shin
authors.affiliation: Department of internal medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea.
authors.forename: Ju-Yeun
authors.initials: JY
authors.lastname: Lee
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D016009:Chi-Square Distribution; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000959:Antihypertensive Agents; D001262:Atenolol
keywords: adherence; atenolol; betaxolol; new-generation beta blocker; persistence