Persistence of Treatment and Blood Pressure Control in Elderly Hypertensive Patients Treated With Different Classes of Antihypertensive Drugs

Abstract

Unsatisfactory blood pressure (BP) control in the treated hypertensive patient is largely related to poor compliance with antihypertensive drug regimens. The aim of the present study was to prospectively evaluate the rate of persistence on treatment and the extent of BP control in 301 elderly, uncomplicated grade I or II hypertensive patients randomly allocated to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), beta-blockers, angiotensin II receptors (ARBs), or diuretics according to an open-label single-blind study design. After 24 months, the percentage of patients continuing their initial therapy was higher in those treated with ARBs (68.5%) and ACE inhibitors (64.5%) and lower in patients taking diuretics (34.4%; P<.01). The logistic regression model using ARBs as reference term showed that patients treated with ACE inhibitors (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.79-0.99) or CCBs (OR, 0.76; 95% CI, 0.54-0.85) were more likely to continue their initial antihypertensive therapy when compared with those treated with beta-blockers (OR, 0.67; 95% CI, 0.57-0.79) or diuretics (OR, 0.56; 95% CI, 0.38-0.84). The average systolic and diastolic BP decrease was greater in patients treated with ARBs (-11.2+/-4/-5.8+/-2 mm Hg), ACE inhibitors (-10.5+/-4/-5.1+/-2 mm Hg), and CCBs (-8.5+/-3/-4.6+/-2 mm Hg) and lesser in those treated with diuretics (-2.3+/-4/-2.1+/-3 mm Hg, P<.05) and beta-blockers (-4.0+/-2/-2.3+/-2 mm Hg; P<.05). The study confirms the importance of persistence with treatment for the effective management of hypertension in clinical practice.

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

“…Patients who viewed hypertension as a symptomatic disease and believed treatment had beneficial effects on symptoms were more adherent and had better BP control. 702 Side Effects: Side effects are another common reason for therapy discontinuation in the elderly [703][704][705] and may be more apparent in patients with hypertension. This because the illness is often asymptomatic, which may increase awareness of side effects associated with therapy.…”

Evidence-based prescribing and adherence to antiplatelet therapy—How much difference do they make to patients with atherothrombosis?

“…In the CURE trial, patients who discontinued clopidogrel therapy between 2 and 4 months after randomisation had a higher rate of subsequent atherothrombotic event than their placebo-treated counterparts (5.8% vs. 3.9%) [70]. A similar effect was noted when patients discontinued clopidogrel therapy between 4 and 12 months after randomisation (3.1% vs. 1.2%) [53]. Discontinuation data are also available from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) study of clopidogrel or placebo plus aspirin in stable patients (n = 15,603) with either symptomatic atherothrombosis or with multiple risk factors (manuscript in development, 2007).…”

“…For example, in one prospective study of 301 elderly (N 65 years) hypertensive patients, as few as 34% were fully adhering to prescribed treatment with diuretics after 24 months [53]. In another 1-year retrospective study involving 60,685 patients receiving antihypertensives (hydrochlorthiazide, amlodipine, lisinopril, or valsartan), 31-44% of subjects had utilized no treatment for at least 60 days [54].…”

Compliance Pengguna Antihipertensi di RSUP DR. SARDJITO Yogyakarta (Periode Juli 2006- Juni 2009)

“…Walaupun demikian ada beberapa penelitian yang menunjukkan hasil yang berbeda yaitu ARB lebih compliance dibandingkan jenis antihipertensi yang lainnya. 15 Penelitian ini menunjukkan bahwa monoterapi cenderung lebih tidak compliance dibandingkan terapi kombinasi, hal ini kemungkinan dikarenakan pasien yang menggunakan lebih dari satu jenis obat merasa penyakitnya lebih berat sehingga mereka lebih perhatian dan serius dalam memakan obatnya secara kontinyu dibandingkan dengan pasien yang menggunakan monoterapi yang merasa penyakitnya lebih ringan. Penelitian ini sesuai dengan penelitian Hashmi di Pakistan yang menunjukkan bahwa terapi kombinasi lebih compliance dibandingkan monoterapi yaitu 90% vs 79%.…”