Persistence, Adherence, and Risk of Discontinuation Associated with Commonly Prescribed Antihypertensive Drug Monotherapies

Abstract

Measurements: Drug utilization following initiation. Cox proportional hazards regression models controlled for demographics, case-mix, and concomitant treatments.Results: Records for 60,685 subjects were included: HCTZ (n ‫؍‬ 18,713), amlodipine (n ‫؍‬ 11,520), lisinopril (n ‫؍‬ 21,138), or valsartan (n ‫؍‬ 9314). Over 1 year, 31% to 44% of subjects utilized no treatment for at least 60 days. Medication possession ratio (MPR) and adherence measures ranged from 73% to 90%. Valsartan was associated with significantly (P < .001) more favorable measures of persistence, length of therapy, time to discontinuation, MPR, and risk of discontinuation, compared with HCTZ, amlodipine, or lisinopril. The risk of discontinuation was 53%, 32%, and 14% greater for HCTZ, amlodipine, and lisinopril, respectively, versus valsartan (all comparisons P < .001). Conclusion: Among antihypertensive agents studied, valsartan was associated with the most favorable utilization patterns. Health care providers and systems should evaluate the use of antihypertensive drugs within their populations to identify and manage treatment discontinuation. (J Am Board Fam Med 2007;20:72-80.)Hypertension is a common and eminently treatable risk factor for major cardiovascular events, including coronary heart disease and stroke.1 Cardiovascular disease is the leading cause of morbidity and mortality in developed nations, 2 and is expected to increase in worldwide importance during the next 20 to 50 years. 3 The prevalence of hypertension seems to be increasing in both developed nations, where it currently affects approximately 1 in 3 adults, 4 and in developing countries. 5Meta-analyses and meta-regression analyses of clinical trials in hypertension have reported that pharmacologic drug therapy significantly reduces cardiovascular events, which is largely attributable This article was externally peer reviewed.

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.…”

The Comparative Effects of Azilsartan Medoxomil and Olmesartan on Ambulatory and Clinic Blood Pressure

“…3 Moreover, within the RAAS classes, those that inhibit the action of angiotensin II by binding directly to the angiotensin type 1 (AT 1 ) receptor (ie, angiotensin receptor blockers [ARBs]) are the best tolerated of all antihypertensive drug classes. 3 Some ARBs have shown efficacy in reducing mortality in patients with heart failure and post-myocardial infarction as well as slowing progression of diabetic nephropathy. [4][5][6][7][8] Azilsartan medoxomil (AZL-M) is an investigational ARB in development for the treatment of hypertension.…”

Anger-In

“…These deficits were absent in hypertensives taking ACE inhibitors (Braszko, Karwowska-Polecka, Halicka, & Gard, 2003). Interestingly, patients taking ACE inhibitors or angiotensin II receptor antagonists are more likely to continue drug therapy compared to patients taking other antihypertensive medications (Elliott, Plauschinat, Skrepnek, & Gause, 2007). However, it is unclear if this is caused by mood-elevating effects of ACE inhibitors or less severe side effects of ACE inhibitors relative to other cardiovascular disorder medications.…”