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. 1999 Jan 12;160(1):31–37.

Persistence with treatment for hypertension in actual practice

J J Caro 1, M Salas 1, J L Speckman 1, G Raggio 1, J D Jackson 1
PMCID: PMC1229943  PMID: 9934341

Abstract

BACKGROUND: Despite the existence of efficacious medications, many patients in actual practice remain with uncontrolled hypertension. Randomized clinical trials, cannot address this issue well given their highly restricted environment. This paper examines persistence with antihypertensive therapy among patients in actual practice. METHODS: Cohort study of patients who received a diagnosis of hypertension and were treated between 1989 and 1994 identified through the Saskatchewan Health databases. Patients with concurrent diagnoses likely to affect initial treatment choice were excluded. The resulting population of 79,591 subjects was grouped into those with established hypertension (52,227 [66%]) and those with newly diagnosed hypertension (27,364 [34%]). The initial antihypertensive prescription, subsequent changes in treatment and persistence with antihypertensive therapy were analysed. RESULTS: Persistence with antihypertensive therapy decreased in the first 6 months after treatment was started and continued to decline over the next 4 years. Of the patients with newly diagnosed hypertension, only 78% persisted with therapy at the end of 1 year, as compared with 97% of the patients with established hypertension (p < 0.001). Among those with newly diagnosed hypertension, older patients were more likely than younger ones to persist, and women were more likely than men to persist (p < 0.001). INTERPRETATION: This analysis of actual practice data indicates that barriers to persistence occur early in the therapeutic course and that achieving successful therapy when treatment is started is important to maintaining long-term persistence.

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Selected References

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  1. Cooper J. K., Love D. W., Raffoul P. R. Intentional prescription nonadherence (noncompliance) by the elderly. J Am Geriatr Soc. 1982 May;30(5):329–333. doi: 10.1111/j.1532-5415.1982.tb05623.x. [DOI] [PubMed] [Google Scholar]
  2. Gueyffier F., Froment A., Gouton M. New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit. J Hum Hypertens. 1996 Jan;10(1):1–8. [PubMed] [Google Scholar]
  3. Hamilton R. A., Briceland L. L. Use of prescription-refill records to assess patient compliance. Am J Hosp Pharm. 1992 Jul;49(7):1691–1696. [PubMed] [Google Scholar]
  4. Hershey J. C., Morton B. G., Davis J. B., Reichgott M. J. Patient compliance with antihypertensive medication. Am J Public Health. 1980 Oct;70(10):1081–1089. doi: 10.2105/ajph.70.10.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Joffres M. R., Hamet P., Rabkin S. W., Gelskey D., Hogan K., Fodor G. Prevalence, control and awareness of high blood pressure among Canadian adults. Canadian Heart Health Surveys Research Group. CMAJ. 1992 Jun 1;146(11):1997–2005. [PMC free article] [PubMed] [Google Scholar]
  6. Jones J. K., Gorkin L., Lian J. F., Staffa J. A., Fletcher A. P. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ. 1995 Jul 29;311(7000):293–295. doi: 10.1136/bmj.311.7000.293. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kannel W. B. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA. 1996 May 22;275(20):1571–1576. [PubMed] [Google Scholar]
  8. Levy D., Larson M. G., Vasan R. S., Kannel W. B., Ho K. K. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22;275(20):1557–1562. [PubMed] [Google Scholar]
  9. Mancia G., Sega R., Milesi C., Cesana G., Zanchetti A. Blood-pressure control in the hypertensive population. Lancet. 1997 Feb 15;349(9050):454–457. doi: 10.1016/s0140-6736(96)07099-7. [DOI] [PubMed] [Google Scholar]
  10. McAlister F. A., Teo K. K., Lewanczuk R. Z., Wells G., Montague T. J. Contemporary practice patterns in the management of newly diagnosed hypertension. CMAJ. 1997 Jul 1;157(1):23–30. [PMC free article] [PubMed] [Google Scholar]
  11. Monane M., Bohn R. L., Gurwitz J. H., Glynn R. J., Levin R., Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens. 1997 Jul;10(7 Pt 1):697–704. doi: 10.1016/s0895-7061(97)00056-3. [DOI] [PubMed] [Google Scholar]
  12. Moser M. Historical perspective on the management of hypertension. Am J Med. 1986 May 23;80(5B):1–11. doi: 10.1016/0002-9343(86)90845-4. [DOI] [PubMed] [Google Scholar]
  13. Neaton J. D., Grimm R. H., Jr, Prineas R. J., Stamler J., Grandits G. A., Elmer P. J., Cutler J. A., Flack J. M., Schoenberger J. A., McDonald R. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993 Aug 11;270(6):713–724. [PubMed] [Google Scholar]
  14. Okano G. J., Rascati K. L., Wilson J. P., Remund D. D., Grabenstein J. D., Brixner D. I. Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker. Clin Ther. 1997 Nov-Dec;19(6):1433–1425. doi: 10.1016/s0149-2918(97)80017-3. [DOI] [PubMed] [Google Scholar]
  15. Pablos-Méndez A., Barr R. G., Shea S. Run-in periods in randomized trials: implications for the application of results in clinical practice. JAMA. 1998 Jan 21;279(3):222–225. doi: 10.1001/jama.279.3.222. [DOI] [PubMed] [Google Scholar]
  16. Pierdomenico S. D., Mezzetti A., Lapenna D., Guglielmi M. D., Mancini M., Salvatore L., Antidormi T., Costantini F., Cuccurullo F. 'White-coat' hypertension in patients with newly diagnosed hypertension: evaluation of prevalence by ambulatory monitoring and impact on cost of health care. Eur Heart J. 1995 May;16(5):692–697. doi: 10.1093/oxfordjournals.eurheartj.a060975. [DOI] [PubMed] [Google Scholar]
  17. Rawson N. S., Malcolm E., D'Arcy C. Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles. Soc Psychiatry Psychiatr Epidemiol. 1997 May;32(4):191–199. doi: 10.1007/BF00788238. [DOI] [PubMed] [Google Scholar]
  18. Rawson N. S., Malcolm E. Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles. Stat Med. 1995 Dec 30;14(24):2627–2643. doi: 10.1002/sim.4780142404. [DOI] [PubMed] [Google Scholar]
  19. Reeves R. A. The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. JAMA. 1995 Apr 19;273(15):1211–1218. doi: 10.1001/jama.273.15.1211. [DOI] [PubMed] [Google Scholar]
  20. Sharkness C. M., Snow D. A. The patient's view of hypertension and compliance. Am J Prev Med. 1992 May-Jun;8(3):141–146. [PubMed] [Google Scholar]
  21. Shea S., Misra D., Ehrlich M. H., Field L., Francis C. K. Correlates of nonadherence to hypertension treatment in an inner-city minority population. Am J Public Health. 1992 Dec;82(12):1607–1612. doi: 10.2105/ajph.82.12.1607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stockwell D. H., Madhavan S., Cohen H., Gibson G., Alderman M. H. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994 Nov;84(11):1768–1774. doi: 10.2105/ajph.84.11.1768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tennis P., Bombardier C., Malcolm E., Downey W. Validity of rheumatoid arthritis diagnoses listed in the Saskatchewan Hospital Separations Database. J Clin Epidemiol. 1993 Jul;46(7):675–683. doi: 10.1016/0895-4356(93)90048-6. [DOI] [PubMed] [Google Scholar]

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