October 5, 2005Journal of Hypertension
Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care
Key result
Persistence with first-line single antihypertensive drugs was low during the first year, with 42.6% of patients discontinuing therapy and only 19.8% continuing their initial medication.
Population
13,303 patients with newly diagnosed hypertension in Italy, who received a first single antihypertensive…
Design
Cohort
Follow-up
1 year
Authors
Discussion
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Implication
Low first-year persistence with initial antihypertensives warrants adherence strategies in practice; leaves open optimal interventions for prospective trials.
Key Points
- To evaluate patterns of treatment persistence and primary care management costs during the first year following an initial antihypertensive prescription.
- Retrospective cohort study conducted during 2000–2001 utilizing clinical data from 320 general practitioners in Italy.
- Included 13,303 patients with newly diagnosed hypertension who initiated a single antihypertensive medication within 3 months of diagnosis.
- Tracked 1-year outcomes classified into continuers, combiners, switchers, and discontinuers, alongside per person-year management costs.
- Only 19.8% of patients continued their initial therapy for at least 1 year, whereas 42.6% discontinued, 22.1% added a drug (combiners), and 15.4% switched medications.
- Continuation was highest for angiotensin II receptor blockers (25.2%), calcium channel blockers (23.9%), and ACE inhibitors (23.3%); discontinuation risk rose with severe hypertension (HR 1.30; 95% CI 1.18–1.43) and severe health status (HR 1.22; 95% CI 1.15–1.30).
- Discontinuers generated 22.4% of primary care costs, while adding medications increased costs by 140.1 per person-year relative to continuers, with diuretics remaining the least expensive initial option.
Study Design
Type
Cohort (n=13,303)
Multicenter
Yes
Structured PICO
P
Population
13,303 patients with newly diagnosed hypertension in Italy, who received a first single antihypertensive prescription within 3 months after diagnosis.
I
Intervention
First-line single antihypertensive treatment (including angiotensin II type 1 receptor blockers, calcium channel blockers, ACE inhibitors, beta-blockers, or diuretics).
O
Outcome
Persistence with first-line single treatment (categorized as continuers, combiners, switchers, discontinuers) and primary care costs (cost of hypertension management per person-year of follow-up).
Persistence with first-line antihypertensive therapy is extremely low during the first year of treatment, highlighting a major gap in hypertension management and potential areas for cost savings.
Limitations
- Further investigations in the long-term are needed to analyse the effects of persistence on therapeutic effectiveness and related costs.
Cite This Study
Mazzaglia et al. (2005) conducted a cohort in newly diagnosed hypertension (n=13,303). first-line single antihypertensive treatment was evaluated on Persistence with first-line single treatment (continuers, combiners, switchers, discontinuers). Persistence with first-line single antihypertensive drugs was low during the first year, with 42.6% of patients discontinuing therapy and only 19.8% continuing their initial medication.