Relation of the first hypertension-associated event with medication, compliance and persistence in naïve hypertensive patients after initiating monotherapy.

Abstract

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.

• Authors: J Mathes, K Kostev, A Gabriel, O Pirk, R E Schmieder
• Journal: International journal of clinical pharmacology and therapeutics (Int J Clin Pharmacol Ther) Vol. 48 Issue 3 Pg. 173-83 (Mar 2010) ISSN: 0946-1965 [Print] Germany
• PMID: 20197011 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents

Topics

• Adult
• Aged
• Antihypertensive Agents (pharmacology, therapeutic use)
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Hypertension (complications, drug therapy, physiopathology)
• Longitudinal Studies
• Male
• Medication Adherence
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Risk