Highlights
- •In incident users, adherence to first-line antihypertensives is suboptimal.
- •Important differences between antihypertensives and lowest for diuretics.
- •Fixed combinations with diuretics may facilitate adherence.
Abstract
Background
Suboptimal adherence to antihypertensives leads to adverse clinical outcomes. This
study aims to determine and compare medication adherence and persistence to different
first-line antihypertensive drug classes in a large cohort.
Methods
A cohort study was performed using claims data for prescriptions in the German statutory
health insurance scheme that insures approximately 90% of the population. A total
of 255,500 patients with a first prescription of an antihypertensive were included
and followed for 24 months. Persistence was determined based on gaps in continuous dispensation. Adherence
was analyzed by calculating the medication possession ratio (MPR).
Results
Within a 2-year period, 79.3% of all incident users of antihypertensive monotherapy
met the classification of non-persistence (gap >0.5 times the number of days supplied with medication) and 56.3% of non-adherence
(MPR < 0.8). Beta-blockers (42.5%) and angiotensin-converting enzyme inhibitors (31.9%) were
the most widely prescribed drug classes. Non-persistence and non-adherence were highest
for diuretics (85.4%, n = 6149 and 66.3%, n = 4774) and lowest for beta-blockers (77.6%, n = 76,729 and 55.2%, n = 54,559). The first gap of antihypertensive medication occurred in median 160–250 days after initiation, and the average medication possession ratio for all drug classes
was less than 0.8. Fixed combinations with diuretics showed a 19.8% lower chance for
non-adherence (OR = 0.802, 99.9% CI = [0.715–0.900], p < 0.001) and an 8.4% lower hazard for non-persistence (HR 0.916, 99.9% CI = [0.863–0.973], p < 0.001) compared with monotherapies.
Conclusions
This large cohort study reveals important differences in 2-year adherence and persistence
between antihypertensives that were lowest for diuretics. Fixed-dose combinations
with diuretics may facilitate adherence compared to single substance products. However,
effective strategies to improve adherence to antihypertensives are needed regardless
of drug class.
Keywords
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Article info
Publication history
Published online: June 28, 2016
Accepted:
June 27,
2016
Received in revised form:
May 19,
2016
Received:
March 26,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
