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Persistence with antihypertensive medication: Australia-wide experience, 2004-2006
Leon A Simons1, Michael Ortiz, Gordon Calcino
1Lipid Research Department, University of New South Wales, St Vincent's Hospital, Sydney, NSW, Australia. l.simons@unsw.edu.au
The Medical Journal of Australia
|February 19, 2008
Summary
Many patients struggle with taking their prescribed antihypertensive (AHT) medications consistently. Poor persistence with these essential drugs, particularly calcium channel blockers, hinders cardiovascular disease prevention efforts.
Area of Science:
- Pharmacology and Therapeutics
- Cardiovascular Medicine
- Public Health
Background:
- Antihypertensive (AHT) medications are crucial for managing hypertension and preventing cardiovascular disease.
- Patient persistence and adherence to long-term AHT therapy are critical for treatment success.
- Understanding factors influencing AHT medication persistence is essential for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the persistence and adherence rates of commonly prescribed antihypertensive medications.
- To identify differences in persistence among major classes of antihypertensive drugs.
- To assess the implications of poor persistence for cardiovascular disease prevention.
Main Methods:
- A longitudinal analysis of Pharmaceutical Benefit Scheme (PBS) claims data from January 2004 to December 2006 was conducted.
- A 10% random sample of Australian long-term health concession card holders initiated on angiotensin II receptor antagonists (A2RAs), angiotensin-converting enzyme inhibitors (ACEIs), or calcium channel blockers (CCBs) were analyzed.
- Key outcome measures included the proportion of patients failing to fill a second prescription, median persistence time, and medication possession ratio (MPR).
Main Results:
- Out of 48,690 patients, 19% did not collect a second prescription, with a median persistence of 20 months.
- Persistence was significantly poorer for calcium channel blockers (CCBs) (57% lower, median persistence 7 months) compared to A2RAs and ACEIs.
- While adherence (MPR) was generally high (around 100%) among those who continued treatment, specific drugs like candesartan, telmisartan, perindopril, and lercanidipine showed better persistence.
Conclusions:
- A significant challenge exists regarding poor persistence with common antihypertensive medications.
- The reduced persistence, especially with CCBs, may compromise the effectiveness of cardiovascular disease prevention strategies.
- Further interventions are needed to improve long-term adherence to antihypertensive therapies.
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