Initial antihypertensive prescriptions, switching patterns and adherence among insured patients in Hawai'i

Practice patterns were investigated for an insured population to determine if prescribing patterns, switching, and relative adherence by drug class for first-line antihypertensive medications adhered to national guidelines.

Drug use was obtained from pharmaceutical claims. Prescriptions were categorized into 6 drug classes for analyses. Adherence with antihypertensive medications was based on a medication possession ratio or 0.8 or greater. For the analyses, 28,073 patients were categorized into groups: hypertension alone, hypertension plus diabetes, and hypertension plus congestive heart failure. Patient and physician characteristics affecting prescribing, switching, and adherence were analyzed using multivariable logistic regression analysis.

Thiazide diuretics were used and adhered to less often, despite national guideline recommendations. New drug classes were used more highly.

Inconsistency exists between guidelines and practice as older, cheaper drugs were used less and more expensive drugs were used more often with better adherence.