Determinants of discontinuation of new courses of antihypertensive medications

Grégoire, Jean‐Pierre; Moisan, Jocelyne; Guibert, R; Ciampi, Antonio; Milot, Alain; Gaudet, Michel; Côté, Isabelle

doi:10.1016/s0895-4356(02)00400-6

Cited by 60 publications

(48 citation statements)

References 17 publications

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“…In a previous analysis of the present cohort, we found discontinuation of initial medication use to be positively associated with the perception of side effects with initial medication, and inversely associated with insurance coverage for medication (18).…”

Section: Clinical Studiessupporting

confidence: 54%

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Grégoire

Moisan

Guibert

et al. 2006

Canadian Journal of Cardiology

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C ardiovascular disease remains the leading cause of mortality in the developed world. Despite evidence that blood pressure control may reduce premature cardiovascular mortality (1,2) and despite the availability of effective treatment for high blood pressure, a large proportion of identified hypertensive individuals do not have his or her blood pressure controlled (ie, diastolic blood pressure is greater than 90 mmHg or systolic blood pressure is greater than 140 mmgHg) (3-5).Poor adherence to the recommended drug regimen constitutes a major barrier to adequate control of high blood pressure (3). Three different aspects can be differentiated within the broader concept of adherence (6). The first aspect is acceptance, BACKGROUND: Persistence and compliance are different aspects of the broader concept of adherence to drug treatment. In a prior study, determinants of nonpersistence in a group of patients newly prescribed antihypertensive medications were examined. OBJECTIVE: To determine noncompliance among those who were persistent with therapy. METHODS: A prospective cohort study was conducted, in which individuals prescribed a new antihypertensive monotherapy were identified through a network of 173 pharmacies. Participants were interviewed by telephone twice during a three-month period. At the end of this period, individuals who reported still taking the medication initially prescribed were included in the analysis. Self-reported noncompliance was measured at three months. Data were analyzed using a multivariate logistic regression model. RESULTS: Of 509 eligible participants, 118 (23.2%) reported noncompliance with their drug treatment. Noncompliance was significantly associated with the use of angiotensin-converting enzyme inhibitors (adjusted OR [AOR] 3.0; 95% CI 1.17 to 7.92) compared with the angiotensin II receptor blocker losartan, and with the belief that hypertension is not a risk factor for cardiovascular diseases (AOR 2.0; 95% CI 1.21 to 3.33). On the other hand, noncompliance was inversely associated with the use of more than four pills of medication per day (AOR 0.3; 95% CI 0.15 to 0.64). CONCLUSIONS: Compliance with drug treatment could be improved by proper selection of medication, and by attempts to correct the false perceptions patients may have about hypertension. Further research is needed to better understand the clinical significance of a higher number of pills as a predictor of good compliance. Further research is also needed using different means of measuring noncompliance.

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Section: Clinical Studiessupporting

confidence: 54%

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Grégoire

Moisan

Guibert

et al. 2006

Canadian Journal of Cardiology

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“…Suggested factors included reimbursement policies, traditions, opinion leaders having conflicts of Persistence with antihypertensive drugs Mazzaglia et al 2097 interests, domestic pharmaceutical production, and clinical practice guidelines. Another study conducted in Canada [21] reported a 25% decreased risk of discontinuation among individuals with medication insurance coverage, compared with other methods of payments. Such factors might therefore have an impact on the selection of the initial drug to be prescribed, but they can only partially explain the different rates of persistence with medication in Italy, because the NHS provides full reimbursement for all classes of antihypertensive drug.…”

Section: Discussionmentioning

confidence: 99%

Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care

Mazzaglia

Mantovani

Sturkenboom

et al. 2005

Journal of Hypertension

170

102

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Persistence with first-line single antihypertensive drugs is extremely low during the first year of treatment. Potential cost saving should be possible by reducing the high frequency of discontinuation. Diuretics represent the least expensive therapeutic option, although further investigations in the long-term are needed to analyse the effects of persistence on therapeutic effectiveness and related costs.

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“…30 A recent Canadian study has shown that the risk of discontinuing a new course of AHT drug therapy is significantly associated with perceived side effects. 24 Yet, patients on AIIAs tend to perceive fewer side effects than those on ACEIs or CCBs. 31 A lack of drug insurance coverage, 24 younger age, 17,20,29 and gender 29 have also been shown to be associated with the risk of discontinuing therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][17][18][19] More recent studies have included AIIAs, most of which had a duration of follow-up of no more than 1 year, [20][21][22] or have limited their interest to persistence with the initial antihypertensive medication. [23][24][25] None of these studies have examined persistence and discontinuation patterns longitudinally, including new courses of therapy after treatment interruptions.…”

Section: Introductionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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The objective was to assess persistence with antihypertensive therapy (AHT) and discontinuation patterns in patients newly dispensed different antihypertensive drug classes in a natural Canadian population-based setting. Hypertensive patients initiating AHT monotherapy were included in this 3-year retrospective cohort study (N ¼ 21 326) using the Saskatchewan health-care databases. Persistence was defined as consistently refilling a new prescription for AHT within 90 days of a previous dispensing. New courses of AHT were also documented in nonpersistent patients. Kaplan-Meier and Cox regression analyses were used to compare persistence and new courses of therapy across initial drugs. Compared to the newer angiotensin II antagonists (AIIAs), the likelihood of discontinuing therapy over the 39-month study period was significantly higher for angiotensin-converting enzymes inhibitors (HR ¼ 1.29; 95% CI ¼ 1.16-1.43), calcium channel blockers (HR ¼ 1.42; 95% CI ¼ 1.27-1.60), beta blockers (HR ¼ 1.62; 95% CI ¼ 1.45-1.80) and diuretics (HR ¼ 1.92; 95% CI ¼ 1.73-2.14). In the year following treatment discontinuation, between 54 and 75% of patients initiated a second course of treatment. Patients initiated on an AIIA had a significantly higher likelihood of starting a new course of therapy after a first treatment discontinuation, compared to all other agents. In conclusion, hypertensive patients initiated on an AIIA not only had greater persistence to AHT but were also more likely to initiate a new course of AHT after discontinuation than those initiating treatment with other agents. Further studies are required that relate intermittent treatment behaviours to health outcomes and costs in hypertension.

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Determinants of discontinuation of new courses of antihypertensive medications

Cited by 60 publications

References 17 publications

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Predictors of self-reported noncompliance with antihypertensive drug treatment: A prospective cohort study

Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

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