Effects of Initial Antihypertensive Drug Class on Patient Persistence and Compliance in a Usual‐Care Setting in the United States

Abstract

T he prevalence of hypertension has continued to rise over the past decades, reaching 31.3% for 1999-2000, 1 possibly as the result of better detection and more specific definitions. only 37% of all patients with hypertension and only 57% of those receiving antihypertensive medication in the united states currently have controlled blood pressure (bp). 2 This is an improvement over prior years, as the national Health and nutrition Examination survey (nHanEs) iii indicated that during the time period of 1991 to 1994, only 22.7% of hypertensive patients had their bp controlled. 3 The current rate remains well below the Healthy people 2010 goal of 50%, set by the us Department of Health and Human services, however. 4 in 2003, the seventh report of the Joint national Committee on prevention, Detection, Evaluation, and Treatment of High blood pressure was published (JnC 7), which included the recommendation of thiazide diuretics for treatment of most patients with uncomplicated hypertension, either alone or in combination with drugs from other antihypertensive classes.5 JnC 7 recommended that thiazide diuretics be used as firststep therapy for hypertension management in the absence of high-risk conditions. Despite these

Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006–2010

“…Clinically appropriate reasons to avoid use of thiazides exist, including electrolyte abnormalities, orthostatic hypotension, and patient preference or nonadherence. 21,22 In fact, the higher likelihood of adverse effects and contraindications (e.g. orthostatic hypertension) seen with older age plausibly explains the age association with lower thiazide use reported here.…”

Real-life treatment patterns, compliance, persistence, and medication costs in patients with hypertension in Germany

“…ARBs have the highest rate of treatment persistence and compliance among anti-hypertensives [23][24][25][26] . For a successful management of hypertension, and other chronic conditions, compliance and persistence are important.…”

Practical issues in medication compliance in hypertensive patients

“…After 1 year, the proportion of patients still taking the initially prescribed medication was 52% for angiotensin II receptor blockers, 48% for angiotensin-converting enzyme inhibitors, 40% for beta-blockers, 38% for calcium antagonists, and 30% for diuretics. 18 Compared with patients receiving diuretics, those treated with other antihypertensive agents were significantly less likely to discontinue therapy. 18 A recent metaanalysis confirms highest adherence to angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors, and lowest adherence to diuretics and beta-blockers.…”

“…18 Compared with patients receiving diuretics, those treated with other antihypertensive agents were significantly less likely to discontinue therapy. 18 A recent metaanalysis confirms highest adherence to angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors, and lowest adherence to diuretics and beta-blockers. 19 In a study of 588 hypertensive patients, intentional nonadherence was reported by 9% of the participants, compared with 31% who reported unintentional nonadherence.…”