Key result
Initiating monotherapy with ARBs was associated with a lower risk of the first hypertension-associated event compared to non-ARBs (aHR 0.81; P<0.05).
Why the study?
Does ARB monotherapy reduce the risk of the first hypertension-associated event compared to other antihypertensive monotherapies in naïve hypertensive patients?
Cohort (n=7,661)
Does ARB monotherapy reduce the risk of the first hypertension-associated event compared to other antihypertensive monotherapies in naïve hypertensive patients?
In naïve hypertensive patients, initiating ARB monotherapy is associated with better compliance, persistence, and a lower risk of first hypertension-associated events compared to most other antihypertensive classes except ACE inhibitors.
OBJECTIVE: To analyze the relation of medication, compliance and persistence with the risk of the first hypertension associated event in naïve hypertensive patients after initiating monotherapy with any of the first-line antihypertensive drug classes. METHODS: A retrospective cohort study in the IMS Disease Analyzer database was performed. The study cohort comprised all previously untreated hypertensive patients who were free from hypertension-associated comorbidities, in whom new monotherapy with angiotensin II receptor blockers (ARBs), ACE-inhibitors (ACEIs), beta-blockers (BBs), calcium channel blockers (CCBs) or diuretics was initiated. Compliance and persistence were determined within 2 years. The relation between medication, compliance, persistence and risk of the first hypertension-associated event was analyzed using a Cox regression model. Outcomes in the ARB cohort were compared with outcomes in each other drug class cohort separately and with outcomes in the group of non-ARBs (pooled data). RESULTS: 7,661 patients were identified with a follow-up of at least 2 years (totaling 45,585 patient-years of follow-up). ARBs were associated with more favorable measures (all p < 0.05) of compliance (0.86 vs. 0.82 and 0.74, respectively) and persistence (509 days vs. 459 and 324 days) compared with the group of non-ARBs and diuretics, respectively. The risk of the first hypertension-associated event was higher (all p < 0.05) with diuretics (adjusted hazard ratio (aHR) 0.68), BBs (0.79), CCBs (0.78), and the group of non-ARBs (0.81) and was similar with ACEIs (aHR 0.93, p = 0.37) compared to ARBs. Overall, high compliance was associated with a reduced risk of the first event (p < 0.05). CONCLUSION: Our real-world data suggest that initiating a treatment with ARB monotherapy shows significant benefits in most outcomes including hypertension-related complications compared to other antihypertensive drug monotherapies. The documented impact of compliance on the risk of the first event should have clinical and policy implications.
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Mathes et al. (2010) conducted a cohort in Hypertension (n=7,661). Angiotensin II receptor blockers (ARBs) vs. Non-ARBs (ACEIs, BBs, CCBs, or diuretics) was evaluated on First hypertension-associated event (aHR 0.81, p=<0.05). Initiating monotherapy with ARBs was associated with a lower risk of the first hypertension-associated event compared to non-ARBs (aHR 0.81; P<0.05).
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