Objective: To study persistence and adherence with the use of common antihypertensive (AHT) medications. Design, setting and participants: Longitudinal assessment of Pharmaceutical Benefit Scheme claim records covering the period January 2004 to December 2006. We analysed a 10% random sample of all Australian long‐term health concession card holders who had been commenced on an angiotensin II receptor antagonist (A2RA), an angiotensin‐converting enzyme inhibitor (ACEI) and/or a calcium channel blocker (CCB), but for whom no AHT medication had been dispensed in the previous 6 months. Main outcome measures: Proportion of patients failing to fill a second prescription; median persistence time with medication (ie, non‐cessation of therapy); persistence with medication over 33 months; median medication possession ratio (MPR, defined as the proportion of prescribed medication actually consumed by patients persisting with treatment). Results: The database yielded information relating to 48 690 patients prescribed AHT medication. Nineteen per cent of patients failed to collect a second prescription. The median persistence time was 20 months. The data were little different from the population average with respect to A2RAs or ACEIs, but persistence was 57% poorer with respect to CCBs (log‐rank P < 0.001) (28% of patients prescribed CCBs failed to collect a second prescription; median persistence time, 7 months). There were differences in persistence between individual drugs in the respective classes, the best outcomes being with candesartan and telmisartan (A2RAs; 10%–20% better), perindopril (ACEI; 25% better) and lercanidipine (CCB; 25% better). Median MPRs were generally around 100%, indicating that most patients who collected prescriptions also showed good adherence to treatment regimens. Conclusion: There is an ongoing problem of poor persistence with commonly used AHT medications. This may represent a diminished opportunity for cardiovascular disease prevention.

Objective To examine the relationship between alcohol intake and survival in elderly people. Design and setting A prospective study over 116 months of non‐institutionalised subjects living in Dubbo, a rural town (population, 34 000) in New South Wales. Participants 1235 men and 1570 women aged 60 years and over who were first examined in 1988‐89. Main outcome measures All‐causes mortality; gross cost of alcohol per life­ year gained. Results Death occurred in 450 men and 392 women. Intake of alcohol was generally moderate (ie, less than 14 drinks/week). Any intake of alcohol was associated with reduced mortality in men up to 75 years and in women over 64 years. In a proportional hazards model, the hazard ratio for mortality in men taking any alcohol was 0.63 (95% Cl, 0.47‐0.84) and in women was 0.75 (95% Cl, 0.60‐0.94). Cardiovascular deaths in men were reduced from 20/100 (95% Cl, 14‐26) to 11/100 (95% Cl, 9‐13) and in women from 16/100 (95% Cl, 13‐19) to 8/100 (95% Cl, 6‐10). The reduction in mortality occurred in men and women taking only 1‐7 drinks/week ‐ hazard ratios, 0.68 (95% Cl, 0.49‐0.94) and 0.78 (95% Cl, 0.61‐0.99), respectively, with a similar protective effect from intake of beer or other forms of alcohol. After almost 10 years' follow‐up, men taking any alcohol lived on average 7.6 months longer, and women on average 2.7 months longer, compared with non‐drinkers. The gross cost for alcohol per life‐year gained if consuming 1‐7 drinks/week was $5700 in men, and $19000 in women. Conclusions Moderate alcohol intake in the elderly appears to be associated with significantly longer survival in men 60‐74 years and in all elderly women

Persistence with NOAC drugs in patients with AF appears to be superior to warfarin. If continued long-term, this alone will be of clinical importance in the prevention of stroke and death.

Use of a single-pill, fixed-dose combination in hypertension is associated with superior persistence and reduced mortality compared with use of two pills, suggesting a higher priority for the use of fixed-dose combinations.