Differences in antihypertensive drug persistence associated with drug class and gender: a PHARMO study

Abstract

These results demonstrate marked differences in persistence between AHT classes, with the highest persistence for ARBs and lowest for diuretics. Women were less persistent with their AHT compared to men. This low persistence leads to suboptimal treatment with a potential for substantial clinical consequences. Especially in women, more attention paid to AHT persistence patterns could improve their cardiovascular outcome.

Do socioeconomic disparities affect accessing and keeping antihypertensive drug therapy? Evidence from an Italian population-based study

“…In agreement with other reports, [22][23][24][25][26] in our setting, more than 55% of patients had already discontinued treatment after 1 year since starting therapy. Poor socioeconomic status has been found to be related to the lack of adherence in antihypertensive drugs in previous studies.…”

Swedish Hypertension Open care retrospective study in men and Women (SHOW)

“…15 In addition, compliance is known to be low on diuretics and the tendency to induce type II diabetes is well-documented. 8,16 In our study men more often received ACE inhibitors compared with women. Men also had a higher prevalence of diabetes mellitus at baseline and this could explain the more frequent use of ACE inhibitors.…”

“…17 The highest persistence has been shown in patients using ARBs. 8 In our study the use of ARBs was unusually high and it cannot be ruled out that this could have contributed to the high rate of patients reaching target blood pressure. However, more than two-thirds of the participating sites were owned by private practitioners and this could also explain the high degree of prescriptions of ARBs because primary health care centres within the regular social security system possibly were more adherent to recommendations by the Medical Products Agency in Sweden where diuretics, calcium channel blockers and ACE inhibitors are recommended as first line antihypertensive therapy.…”

“…7 Owing to few side effects and better compliance, newer pharmacological treatments blocking the renin-angiotensin-aldosterone system are frequently used in the treatment of hypertension in primary care and there are evidence of a better cost benefit profile with these drugs. 8 Few studies have been designed to evaluate whether gender has a role in the response to treatment of new onset of hypertension. Several observational studies have established that there are differences in the choice of treatment with respect to gender but studies in clinical practice are scarce.…”

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

“…Thirty-nine studies (22 new, including three evaluating a DRI) reported at least some quantitative information on persistence or adherence. 11,13,14,16,26,30,36,37,[42][43][44]47,48,50,55,57,58,62,73,76,81,88,89,[93][94][95]97,98,[106][107][108][109][110][111][112][113][114][115][116][117][118] Adherence to study protocol, in terms of pill counts, was universally high: at least 97% in five of the nine studies assessed and above 90% in all nine, without significant between group differences. Persistence with ARBs was modestly better than with ACE inhibitors, primarily due to adverse effects.…”