Key result
Antihypertensive therapy yields only ~53% persistence at 5 years, with most changes in year one.
Why the study?
To estimate persistence with antihypertensive therapy and describe treatment changes and associated factors among persistent patients over 5 years.
Cohort (n=22,027)
Yes
Antihypertensive therapy is frequently modified early after initiation, with long-term persistence declining to 80.7% at 5 years, highlighting the need for ongoing patient support.
Low 5-year antihypertensive persistence may warrant early monitoring; extends real-world adherence data but leaves open randomized intervention trials.
Aim To estimate persistence with antihypertensive therapy (AHT) and describe treatment changes and associated factors among persistent patients over 5 years. Methods 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. Results 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. Conclusion Antihypertensive pharmacotherapy is frequently modified early after initiation, followed by increasing long‐term treatment stability among persistent users.
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Asiri et al. (2026) conducted a cohort in Hypertension (n=22,027). Antihypertensive therapy was evaluated on Rate of antihypertensive therapy persistence over the 5-year follow-up period. Antihypertensive therapy initiation resulted in a 52.7% persistence rate over 5 years, with treatment changes being most frequent in the first year.
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