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Real-world adherence and persistence associated with nebivolol or hydrochlorothiazide as add-on treatment for
Stephanie Chen1, Dendy Macaulay, Elyse Swallow
1Forest Research Institute , Jersey City, NJ , USA.
Insights
Nebivolol demonstrated superior adherence and persistence compared to hydrochlorothiazide (HCTZ) as an add-on hypertension treatment. Patients on nebivolol maintained higher medication possession ratios and longer persistence, indicating better treatment compliance.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Hypertension management often requires add-on therapies when initial treatments are insufficient.
- Comparing adherence and persistence of different antihypertensive medications is crucial for optimizing patient outcomes.
- Nebivolol and hydrochlorothiazide (HCTZ) are commonly used in combination therapy for hypertension.
Purpose of the Study:
- To compare medication adherence and persistence between nebivolol and HCTZ when used as add-on treatments for hypertension.
- To evaluate the real-world effectiveness of these two drug classes in maintaining long-term patient compliance.
Main Methods:
- A retrospective claims database analysis identified adult patients initiating nebivolol or HCTZ as first add-on therapy for hypertension.
- Inverse propensity score weighting was employed to balance baseline characteristics, comorbidities, and costs between the two groups.
- Adherence (Medication Possession Ratio) and persistence were assessed at 6, 9, and 12 months post-initiation.
Main Results:
- After propensity score weighting, baseline characteristics were well-balanced between the nebivolol (n=722) and HCTZ (n=2166) groups.
- At 12 months, nebivolol was associated with a significantly higher Medication Possession Ratio (0.76 vs. 0.70, P < 0.001) compared to HCTZ.
- Nebivolol also demonstrated significantly longer medication persistence (273 days vs. 245 days, P < 0.001) at 12 months.
Conclusions:
- Nebivolol use as an add-on therapy for hypertension was associated with significantly higher adherence and persistence rates compared to HCTZ.
- These findings suggest potential benefits of nebivolol in improving long-term patient compliance in hypertension management.
- Limitations include the inherent constraints of insurance claims data, lacking clinical details.
Objective:
To compare adherence and persistence associated with nebivolol and hydrochlorothiazide (HCTZ) as add-on hypertension treatments.
Research Design And Methods:
Adults with ≥1 hypertension diagnosis (ICD-9-CM 401-405) who used nebivolol or HCTZ as their first add-on antihypertensive therapy between 1/1/2008 and 9/30/2010 were identified from a large claims database. Patients had continuous enrollment for ≥1 year preceding (baseline period) and following (study period) the first qualifying prescription fill, and did not use nebivolol or HCTZ during the baseline period. A random sample of HCTZ patients meeting selection criteria were selected in a 3:1 ratio to nebivolol patients.
Main Outcome Measures:
The probability of receiving each drug, adjusted for baseline patient demographics, significantly different comorbidities, and costs was estimated using a logistic model. Inverse propensity score weights were used to balance confounding factors for between-cohort comparisons. Adherence (estimated using the medication possession ratio [MPR]) and persistence (estimated as days from initiation to the first >30 day gap in the index drug supply) at 6, 9, and 12 months were compared using weighted t tests.
Results:
Baseline characteristics of nebivolol (n = 722) and HCTZ (n = 2166) patients were well balanced after weighting. At 12 months, nebivolol patients had a significantly higher MPR than HCTZ patients (0.76 vs. 0.70, P < 0.001), and medication persistence was 28 days longer (273 vs. 245 days, P < 0.001). Between-group differences were also significant at 6 and 9 months.
Conclusions:
When used as an add-on therapy for hypertension, nebivolol was associated with significantly higher rates of adherence and persistence compared with HCTZ, after adjusting for baseline differences between treatment groups. These results may be impacted by limitations inherent in insurance claims data, such as the lack of clinical information.
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