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

• Published in: Journal of Korean medical science Vol. 30; no. 12; pp. 1800 - 1806
• Main Authors: Ah, Young-Mi, Lee, Ju-Yeun, Choi, Yun-Jung, Kim, Baegeum, Choi, Kyung Hee, Kong, Jisun, Oh, Jung Mi, Shin, Wan Gyoon, Lee, Hae-Young
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.12.2015; 대한의학회
• Subjects: 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; Antihypertensive Agents - therapeutic use; Calcium Channel Blockers - therapeutic use; Cohort Studies; Female; Humans; Hypertension - drug therapy; Male; Medication Adherence; Middle Aged; Original; Republic of Korea; Retrospective Studies; Sodium Chloride Symporter Inhibitors - therapeutic use; Young Adult; 의학일반; Adherence; Persistence; Uncomplicated Hypertension; Therapeutic Class
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2015.30.12.1800

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.