Persistence with Antihypertensive Medications in Uncomplicated Treatment-Naive Patients: Effects of Initial Therapeutic Classes

We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.

An analysis of prescription patterns in cases of uncomplicated hypertension in a tertiary care hospital.

Background & objectives- Prescribing pattern in hypertension patients were found to be different from the recommended guidelines in the past. The objectives of the present study were to analyze prescribing trends in uncomplicated hypertension and to compare with those of current international guidelines with the objective to note any deviation. Methods- A prescription based analysis in 1400 hundred uncomplicated hypertensives in the age group 30 to 60 years was carried out. Results- Monotherapy was prescribed to 893 cases (M 407; F 486) and combination therapy to 507 cases (M 342; F 165). Overall, Calcium Channel Blockers (CCBs) were the most common agents used 787 (56.21%) cases, 350 monotherapy and 437 as combination therapy. Angiotensin Converting Enzyme Inhibitors (ACE I) 452 (32.28%) and Angiotensin II Receptor Blockers (ARBs) 231 (16.5%) cases were the next preferred groups. In double drug combination CCB+ Beta Blockers (BB) and for triple drug combination CCB+ARB+ Diuretics (D) were more preferred. A significant effect of age (p<0.01) on prescription of CCBs was noted. Prescription of ARBs and D were significantly (p<0.05 and <0.01 respectively) influenced by gender. Gender had no significant effect on the prescribing trend of antihypertensive agents in combination therapy, while a significant effect (p<0.05) of age and combined drug classes CCB+ACE I and CCB+BB+D was noted. The overall prescription rate for diuretics was 40.24% and that for monotherapy was meagre 5.15% (M 1.23%±; F 3.92%). Diuretics were always prescribed in triple drug combinations. Interpretation & Conclusions- CCBs were the most commonly prescribed agents. A deviation existed between antihypertensives prescribed and current international guidelines thus calling upon greater awareness.