Persistence and adherence to antihypertensive treatment in relation to initial prescription: Diuretics versus other classes of antihypertensive drugs

Department of Neurosciences, Federico II University, Naples, Italy.
Journal of Hypertension (Impact Factor: 4.72). 04/2012; 30(6):1225-32. DOI: 10.1097/HJH.0b013e328353398b
Source: PubMed


The use of thiazide diuretics in the treatment of hypertension is widely considered as a first-line treatment, given the efficacy and low cost of this class of drugs. This indication is not unanimous, because thiazides can cause metabolic alterations, and other side effects that reduce compliance and persistence on treatment.
In a multicentre, open-label randomized study we compared adherence and persistence to therapy of chlortalidone versus other treatments, as a first-line antihypertensive therapy.
Ninety-two general practitioners (GPs) recruited 2409 hypertensive patients with indication to antihypertensive therapy, who were randomized in two arms to start treatment with chlortalidone (12.5-25 mg daily) or any other single medications (excluding thiazides). The patients have been followed for at least 2 years.
Patients receiving diuretic therapy as first-line antihypertensive treatment, modified antihypertensive treatment regimen more often than the others (79.1 versus 43.9%; χ (2)< 0.0001). Patients starting with diuretics received greater number of drugs, compared to patients starting with different antihypertensive therapy (1.55 versus 1.4 antihypertensive drugs; P < 0.0001), but achieved the same blood pressure (BP) control during the follow-up. No differences were observed in persistence and adherence to treatment between the two groups.
Our results demonstrate that the recommendation to start antihypertensive therapy with diuretics, when no compelling indications are present, is not supported by the evidence that this strategy produces more rapid and better control of BP.

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    ABSTRACT: Introduction The recommendation to start antihypertensive therapy with diuretics (D) might produce delay in blood pressure (BP) control and, possibly, increase cost/benefit ratio. Aim We evaluate the effects of D in relation to the administration of other anti-hypertensive medications, in clinical practice. Methods General practitioners recruited 2,409 hypertensive patients with indication to antihypertensive therapy, who were randomized to start treatment with chlorthalidone (12.5-25 mg daily, group D) or any other single medications (excluding thiazides, group A). The patients have been followed for at least 2 years. Result Among the 2,409 patients recruited (42.5 % women), 1,205 were randomized in group D and 1,204 in group A, of which 1,051 (or 87 %) and 1026 (or 85 %) respectively, completed the study. The number of patients in optimal BP control was similar in the two groups (65.0 vs 64.0 %; p = NS). During follow-up, the group D had prescribed a slightly greater number of medications compared to the group A who added D as second line (2.3 vs 2.1; p p p = NS). Conclusion The beginning of antihypertensive therapy with diuretics is more often subject to the addition of one or more medications to obtain an effective blood pressure control, since the diuretic administered at the beginning of the antihypertensive regimen is only rarely associated with optimal blood pressure control.
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    ABSTRACT: Objective To determine the persistence to oral antiviral therapy or time until change of treatment in previously untreated patients with chronic hepatitis B (CHB). Methods A prospective observational study was performed on an adult population with CHB who had started oral antiviral therapy. The recruitment period was 2 years, and the individual follow-up period was 1 year. Monitoring was performed by quarterly completion of electronic case reports by the pharmacy services of participating hospitals in the study. Statistical analysis was performed using the statistical programme PASW V.18.0. Results A total of 584 patients from 33 hospitals throughout Spain were recruited. Almost all of the patients (99.5%) were on monotherapy, though a few patients (0.5%) were on combined therapy. The drugs that were most commonly prescribed for monotherapy were tenofovir (58.2%), entecavir (35.0%) and lamivudine (4.6%). Treatment persistence during the follow-up year was 83.2%. The reason for non-persistence with treatment for the rest of the patients (16.8%) was discontinuation of treatment (90.8%) or change in the active ingredient (9.2%). Conclusions There is a high rate of therapy persistence in patients with CHB who begin antiviral treatment in Spain. Today, monotherapy is the most frequently used regimen in this patient population, and tenofovir and entecavir are the most commonly used drugs.
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