Long-Term Persistence and Treatment Changes of Antihypertensive Therapy: A 5-Year Cohort Study

To estimate persistence with antihypertensive therapy (AHT) and describe treatment changes and associated factors among persistent patients over 5 years.

We conducted a longitudinal cohort study using the IADB.nl pharmacy database in the Netherlands, including adults who initiated AHT between 2014 and 2018 after a 2-year washout. Persistence was assessed annually using a ±45-day window around each treatment anniversary. Among patients persistent throughout follow-up, treatment changes were classified yearly as no change, switching, intensification or de-intensification. A Markov model estimated transitions between treatment states, and logistic regression evaluated baseline factors associated with treatment changes.

Among 22 027 starters (mean age 58.1 years, 51.1% women), annual persistence declined from 88.8% in year 1 to 80.7% in year 5, with 52.7% remaining persistent over 5 years. Treatment changes were most frequent in the first year, when 53.5% of persistent patients underwent intensification, de-intensification, or switching, and declined thereafter. The probability of remaining in the same state was high, particularly for 'no change' state (0.86). Female sex, combination therapy initiation and initiating on beta-blockers or calcium-channel blockers were associated with treatment changes.

Antihypertensive pharmacotherapy is frequently modified early after initiation, followed by increasing long-term treatment stability among persistent users.