Giuseppe Mancia1, Antonella Zambon, Davide Soranna, Luca Merlino, Giovanni Corrao. 1. aIRCCS Istituto Auxologico Italiano, Milan bCentro Interuniversitario di Fisiologia Clinica e Ipertensione cUniversity of Milano-Bicocca dDepartment of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca eOperative Unit of Territorial Health Services, Region Lombardia, Milan, Italy.
Abstract
OBJECTIVES: We have previously shown that in Italian region of Lombardy (about 10 million citizens), adherence to antihypertensive treatment is low, and that this is associated with a greater risk of hospitalization for cardiovascular events. In this study, we used a healthcare database to study the factors involved in discontinuation of antihypertensive drug prescriptions in real life. METHODS AND RESULTS: The analysis was restricted to 493 623 new users of antihypertensive drugs (no prescriptions in the previous 3 years) recruited in 2003, 2006 and 2009. Discontinuation was defined as lack of prescription renewal for at least 3 months. Each patient was followed at most for 1 year. The adjusted risk of treatment discontinuation depended on the type of initial antihypertensive treatment (diuretic monotherapy associated with higher risk) and it was lower in men (-17%) and older (-21 to -29%) patients, in patients with co-treatment with antidiabetic drugs, or hospitalization for cardiovascular or renal disease (-12 to -27%), but greater in patients under co-treatment with antidepressant drugs or hospitalization for concomitant pulmonary, rheumatic, neoplastic or neurological diseases (+9 to +32%). An unexpected relationship between discontinuation of treatment and density of the population of patient's residence, with a much greater discontinuation in metropolitan areas, was observed. CONCLUSIONS: In a real life setting, discontinuation of antihypertensive treatment is affected in an opposite direction by a large number of factors: type of antihypertensive treatment, co-treatments, clinical conditions and even demographic characteristics of the geographical area where the patient lives. Knowledge of these factors may help the effort to reduce this phenomenon.
OBJECTIVES: We have previously shown that in Italian region of Lombardy (about 10 million citizens), adherence to antihypertensive treatment is low, and that this is associated with a greater risk of hospitalization for cardiovascular events. In this study, we used a healthcare database to study the factors involved in discontinuation of antihypertensive drug prescriptions in real life. METHODS AND RESULTS: The analysis was restricted to 493 623 new users of antihypertensive drugs (no prescriptions in the previous 3 years) recruited in 2003, 2006 and 2009. Discontinuation was defined as lack of prescription renewal for at least 3 months. Each patient was followed at most for 1 year. The adjusted risk of treatment discontinuation depended on the type of initial antihypertensive treatment (diuretic monotherapy associated with higher risk) and it was lower in men (-17%) and older (-21 to -29%) patients, in patients with co-treatment with antidiabetic drugs, or hospitalization for cardiovascular or renal disease (-12 to -27%), but greater in patients under co-treatment with antidepressant drugs or hospitalization for concomitant pulmonary, rheumatic, neoplastic or neurological diseases (+9 to +32%). An unexpected relationship between discontinuation of treatment and density of the population of patient's residence, with a much greater discontinuation in metropolitan areas, was observed. CONCLUSIONS: In a real life setting, discontinuation of antihypertensive treatment is affected in an opposite direction by a large number of factors: type of antihypertensive treatment, co-treatments, clinical conditions and even demographic characteristics of the geographical area where the patient lives. Knowledge of these factors may help the effort to reduce this phenomenon.
Authors: F Fici; G Seravalle; N Koylan; I Nalbantgil; N Cagla; Y Korkut; F Quarti-Trevano; W Makel; G Grassi Journal: High Blood Press Cardiovasc Prev Date: 2017-05-11
Authors: Seyed Hamidreza Mahmoudpour; Folkert W Asselbergs; Patrick C Souverein; Anthonius de Boer; Anke H Maitland-van der Zee Journal: Br J Clin Pharmacol Date: 2018-07-24 Impact factor: 4.335
Authors: Roland E Schmieder; Christian Ott; Axel Schmid; Stefanie Friedrich; Iris Kistner; Tilmann Ditting; Roland Veelken; Michael Uder; Stefan W Toennes Journal: J Am Heart Assoc Date: 2016-02-12 Impact factor: 5.501
Authors: Miriam Qvarnström; Thomas Kahan; Helle Kieler; Lena Brandt; Jan Hasselström; Kristina Bengtsson Boström; Karin Manhem; Per Hjerpe; Björn Wettermark Journal: Medicine (Baltimore) Date: 2016-10 Impact factor: 1.889