Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.
ABSTRACT Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.
To identify factors associated with poorer adherence to antihypertensive treatment.
The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records.
Of the patients, 2234/3799 (58.8%) stopped >or= 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective beta-blockers (59%), and the lowest with non-selective beta-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%).
Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence.
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ABSTRACT: Antihypertensive drug treatment (AHT) is effective in reducing the risks of cardiovascular events, but long-term persistence is required to achieve these benefits. The aim of the present study was to evaluate persistence with antihypertensive treatment in France. A total of 6924 patients, first prescribed for hypertension in 2008, were retrospectively studied from the principal French National Public Health Insurance Scheme database. Persistence was defined as remaining on therapy at the end of the 12 months postindex date. Cox proportional hazards regression models controlled for demographics and cardiovascular profile. Over 1 year, 65% of patients were persistent and 16% maintained the initial therapy. When correcting for significant factors determining persistence, a 13% risk reduction of discontinuation is observed with angiotensin II antagonists (AIIAs) and 11% with angiotensin-converting enzymes inhibitors (ACE) compared with thiazide diuretics. Persistence therapy depended significantly on the cardiovascular profile. In the secondary prevention subgroup (18% of the study population), no statistically significant differences were observed between thiazide diuretics and the four major classes. In contrast, a 19% risk reduction of discontinuation is observed with AIIA and with ACE compared with thiazide diuretics for primary prevention patients without diabetes or hyperlipidaemia. When choosing AHT agents for patients with essential hypertension, practitioners are primarily driven by the cardiovascular profile of patients. The study suggests that the therapeutic decision must encompass the individual 'persistence risk', the latter not being independent from the cardiovascular risk.International Journal of Clinical Practice 12/2013; 67(12):1334-1341. · 2.54 Impact Factor
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ABSTRACT: The aim of this review was to summarize recent findings on patients’ adherence and persistence to antihypertensive (AHT) therapy. A literature search was performed using MEDLINE for original studies published in the English language between April 2003 and July 2008. According to selection criteria, the review included 47 papers classified into the following groups: (i) studies assessing overall behaviour towards treatment; (ii) studies differentiating among AHT classes; and (iii) studies comparing specific AHTs. It was not possible to perform a meta-analysis due to the wide variety of study designs, objectives and definitions. However, some strong messages emerged: non-adherent patients have higher blood pressure (BP) values, which lead to a higher risk of cardiovascular events; angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) are the AHTs with the best patient adherence and persistence to treatment; better treatment adherence is observed in patients using fixed versus extemporaneous AHT combinations. Improving BP control is pivotal to reduce cardiovascular events, allowing for a better use of healthcare resources, and good adherence and persistence to treatment are essential for reaching this goal.High Blood Pressure & Cardiovascular Prevention 01/2009; 16(3):101-110.
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ABSTRACT: To determine factors associated with low persistence in patients initiated on drug treatment for hypertension. Cohort study using medical records for patients with hypertension in 48 Swedish primary healthcare centres. Data were linked to national registers on dispensed drugs, hospitalizations, outpatient hospital consultations, deaths, migration, and socioeconomy. We identified 5225 patients (55 % women, mean age 61 years) initiated on antihypertensive drug treatment during 2006-2007. Persistence was measured for two years by the dispensed drugs. Patients with a gap of >30 days between end of dispensed supply and the next dispensed prescription were classified as non-persistent. This was calculated by Kaplan-Meier analysis. Cox proportional hazard regression was used to estimate hazard ratios for discontinuation. Potential predictors included age, gender, blood pressure before initiation of therapy, cardiovascular comorbidity, educational level, country of birth, and income. Among patients with a dispensed first prescription, 26 % discontinued treatment during the first year, and a further 9 % discontinued during the second year. Discontinuation (all adjusted) was more common in men (P = 0.002) and in younger patients (30-49 years, P < 0.001). Systolic (P < 0.001) but not diastolic blood pressure was positively associated with persistence. Native-born Swedish citizens and patients born in the other Nordic countries had lower discontinuation rates than those born outside the Nordic countries (P < 0.001). Major determinants of discontinuation of antihypertensive drug treatment are male sex, young age, mild-to-moderate systolic blood pressure elevation, and birth outside of Sweden.European Journal of Clinical Pharmacology 07/2013; · 2.70 Impact Factor