Welcome to InCirculation.net
InCirculation.net is a professional cardiovascular resource intended for a global audience of specialists, generalists, researchers, and other healthcare professionals
Cardiovascular news provides daily news updates to help you stay informed.
Antihypertensives differ on long-term adherence
20 October 2005
A Dutch study has revealed large differences in the long-term use of different classes of antihypertensive drugs.
The results showed that patients were less likely to discontinue medication if started on calcium antagonists or ACE inhibitors than if begun on diuretics.
The authors, based at Utrecht Institute for Pharmaceutical Sciences, also found that overall persistence in this real-world analysis was lower than that seen in clinical trials, with just 39% of patients using the drugs continually for 10 years.
The retrospective cohort study examined information held on the PHARMO medical record linkage system, which includes drug-dispensing records for approximately 950,000 people in The Netherlands.
Specifically, the team studied 2325 patients who started using antihypertensive drugs, with two or more prescriptions, in 1992, and who had not been prescribed blood pressure lowering treatment in the prior year.
Results showed that older patients were more likely to persist with use, such that those aged 40-59 years were twice as likely to continue taking the drugs than 20-39-year-olds.
Patients using diuretics alone were more likely to discontinue treatment than those who used dihydropyridine calcium antagonists (odds ratio [OR]=0.54) or ACE inhibitors (OR=0.38), but there was a trend towards greater discontinuation with diuretics plus beta blockers.
Discontinuation was also less common in patients started on combination therapy (OR=0.29) or those treated initially by a cardiologist (OR=0.82) or internist (OR=0.80) compared with those treated by general practitioners.
Reporting in the Journal of Hypertension, Boris Van Wijk and team suggest: "Initially treating patients with ACE inhibitors could be a straightforward approach to increase continuous use.
"Although effectiveness with regard to the reduction of cardiovascular morbidity and mortality seems to be in favor of thiazide diuretic therapy, the higher discontinuation rates may counterbalance the relatively small advantage with regard to effectiveness and costs.
They therefore conclude: "Guidelines should also take long-term persistence into account with regard to the choice of the initial agent."
