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A population-based European cohort study of persistence in newly diagnosed hypertensive patients
J Hasford1, A Mimran, W R Simons
1Department for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany. has@ibe.med.uni-muenchen.de
Insights
Patients taking irbesartan, an angiotensin II receptor antagonist (AIIRA), showed the highest persistence with antihypertensive therapy after one year. This suggests medication choice impacts long-term blood pressure control.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Antihypertensive therapy adherence is crucial for effective blood pressure management.
- Understanding factors influencing patient persistence with initial treatment is essential for optimizing hypertension care.
- Previous studies have highlighted variability in adherence across different drug classes.
Purpose of the Study:
- To assess 1-year persistence rates among patients initially prescribed monotherapy for hypertension.
- To compare persistence rates for irbesartan (an angiotensin II receptor antagonist - AIIRA) against other AIIRAs and different antihypertensive drug classes.
- To identify which initial antihypertensive monotherapy is associated with the highest patient persistence.
Main Methods:
- Retrospective analysis of medical records for 2416 patients with newly diagnosed hypertension across Germany, France, and the UK.
- Patients were prescribed initial antihypertensive monotherapy by general practitioners.
- Persistence rates were compared among irbesartan, other AIIRAs, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, losartan, and diuretics.
Main Results:
- Irbesartan demonstrated the highest persistence rate at 60.8% after 1 year.
- Other AIIRA agents showed a persistence rate of 51.3%.
- Angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and losartan had comparable persistence rates (42.0%-49.7%), while diuretics had the lowest (34.4%).
Conclusions:
- Initial prescription of irbesartan is associated with significantly higher patient persistence compared to other antihypertensive classes.
- Patient persistence with antihypertensive therapy is a key factor for achieving sustained blood pressure control.
- Optimizing antihypertensive prescribing based on efficacy and tolerability may improve long-term adherence and outcomes.
Abstract:
This study assessed the percentage of patients after 1 year who persisted on initially prescribed antihypertensive therapy. Medical records of 2416 patients with newly diagnosed hypertension who were prescribed initial antihypertensive monotherapy by general practitioners in Germany, France, and the United Kingdom were evaluated. Comparisons were made among the angiotensin II receptor antagonist (AIIRA) irbesartan, all other antihypertensive classes (including AIIRAs other than irbesartan), and the AIIRA losartan. Patients initiated on the AIIRA irbesartan scored highest with a persistence rate of 60.8%, followed by patients who received all other AIIRA agents with a persistence rate of 51.3%. Angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and losartan were associated with comparable persistence rates, between 42.0% and 49.7%. Patients who received diuretics scored lowest with a persistence rate of 34.4%. Persistence has emerged as an essential factor for blood pressure control. Prescribing an antihypertensive agent that provides a favourable efficacy and tolerability profile may provide greater persistence with therapy and hence a higher level of blood pressure control.