The objective was to assess persistence with antihypertensive therapy (AHT) and discontinuation patterns in patients newly dispensed different antihypertensive drug classes in a natural Canadian population-based setting. Hypertensive patients initiating AHT monotherapy were included in this 3-year retrospective cohort study (N ¼ 21 326) using the Saskatchewan health-care databases. Persistence was defined as consistently refilling a new prescription for AHT within 90 days of a previous dispensing. New courses of AHT were also documented in nonpersistent patients. Kaplan-Meier and Cox regression analyses were used to compare persistence and new courses of therapy across initial drugs. Compared to the newer angiotensin II antagonists (AIIAs), the likelihood of discontinuing therapy over the 39-month study period was significantly higher for angiotensin-converting enzymes inhibitors (HR ¼ 1.29; 95% CI ¼ 1.16-1.43), calcium channel blockers (HR ¼ 1.42; 95% CI ¼ 1.27-1.60), beta blockers (HR ¼ 1.62; 95% CI ¼ 1.45-1.80) and diuretics (HR ¼ 1.92; 95% CI ¼ 1.73-2.14). In the year following treatment discontinuation, between 54 and 75% of patients initiated a second course of treatment. Patients initiated on an AIIA had a significantly higher likelihood of starting a new course of therapy after a first treatment discontinuation, compared to all other agents. In conclusion, hypertensive patients initiated on an AIIA not only had greater persistence to AHT but were also more likely to initiate a new course of AHT after discontinuation than those initiating treatment with other agents. Further studies are required that relate intermittent treatment behaviours to health outcomes and costs in hypertension.

Our analysis suggests that adding ezetimibe to atorvastatin for patients not achieving treatment goals with their current atorvastatin dose produces greater clinical benefits than treatment with a fixed-dose atorvastatin or atorvastatin titration at an increased overall cost. The cost-effectiveness ratios provide strong evidence for the adoption of ezetimibe within the Canadian healthcare system.

This paper investigates whether solitary drinking is a risk factor for alcohol-related problems using data from a general population of drinkers in Montréal, Canada. Three indicators of solitary drinking were used: (1) having had a drink alone; (2) frequency of solitary drinking; and (3) having had five drinks or more in a solitary setting. Among the 2015 respondent drinkers of a telephone survey, 31% reported drinking alone, of whom 27% did so more than once a week, and 17% had had five drinks or more alone at least once. Problems with family or social relationships, physical health, work, budget, physical security and happiness or view of life, self-reported as being alcohol-related, were measured by seven binary items. Strong positive associations were found at the univariate level between overall alcohol-related problems and both solitary drinking and having had five or more drinks alone, whereas frequency of solitary drinking had no effect. Only the relationship with having five or more drinks alone remained statistically significant in logistic regressions controlling for potential confounders. No evidence was found that solitary drinking per se is a risk factor for alcohol-related problems unless large quantities of alcohol are involved.