Key result
Compared with angiotensin receptor blockers, the risk of antihypertensive therapy discontinuation over one year was significantly increased with initial use of thiazide diuretics (HR 3.16) and beta blockers (HR 1.86).
Why the study?
Does the initial therapeutic class affect one-year persistence and adherence to antihypertensive therapy in newly treated uncomplicated hypertensive patients?
Cohort (n=45,787)
Yes
Does the initial therapeutic class affect one-year persistence and adherence to antihypertensive therapy in newly treated uncomplicated hypertensive patients?
Effect estimate: HR 3.16 (95% CI 2.96-3.74)
p-value: p=<0.001
In treatment-naïve uncomplicated hypertensive patients, initiating therapy with ARBs is associated with significantly higher one-year treatment persistence compared to thiazide diuretics, beta-blockers, and CCBs.
May inform initial ARB selection to improve persistence; leaves open need for RCTs to confirm class effects.
We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.
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Ah et al. (2015) conducted a cohort in Uncomplicated hypertension (n=45,787). Thiazide diuretics vs. Angiotensin receptor blockers (ARB) was evaluated on Antihypertensive therapy discontinuation (non-persistence) (HR 3.16, 95% CI 2.96-3.74, p=<0.001). Compared with angiotensin receptor blockers, the risk of antihypertensive therapy discontinuation over one year was significantly increased with initial use of thiazide diuretics (HR 3.16) and beta blockers (HR 1.86).
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