J Korean Med Sci.  2015 Dec;30(12):1800-1806. 10.3346/jkms.2015.30.12.1800.

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

• Ah YM
• Lee JY
• Choi YJ
• Kim B
• Choi KH
• Kong J
• Oh JM
• Shin WG
• Lee HY

• KMID: 2359964
• DOI: http://doi.org/10.3346/jkms.2015.30.12.1800

Abstract

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.

Keyword

Uncomplicated Hypertension; Persistence; Adherence; Therapeutic Class

MeSH Terms

Adolescent
Adrenergic beta-Antagonists/therapeutic use
Adult
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists/therapeutic use
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Antihypertensive Agents/classification/*therapeutic use
Calcium Channel Blockers/therapeutic use
Cohort Studies
Female
Humans
Hypertension/*drug therapy
Male
Medication Adherence
Middle Aged
Republic of Korea
Retrospective Studies
Sodium Chloride Symporter Inhibitors/therapeutic use
Young Adult
Adrenergic beta-Antagonists
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Calcium Channel Blockers
Sodium Chloride Symporter Inhibitors

Figure

• 

  Fig. 1 Treatment persistence rate over the first year: initial therapeutic class effect. The first year treatment persistence of initial drug classes prescribed for uncomplicated treatment naïve antihypertensive patient show significant difference in adjusted Kaplan Meier curve. Antihypertensive therapy discontinuation among thiazide diuretics (D) or selective beta blockers (BB) groups was significantly higher than angiotensin receptor blockers (ARB). Also, rate of dihydropyridine calcium channel blockers (CCB) discontinuation were slightly higher than ARB. No difference in treatment discontinuation within angiotensin converting enzyme inhibitors (ACEI) and ARB class was observed.

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