Factors involved in the discontinuation of antihypertensive drug therapy: An analysis from real life data

Giuseppe Mancia, Antonella Zambon, Davide Soranna, Luca Merlino, Giovanni Corrao

Research output: Contribution to journalArticle

44 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1708-1716
Number of pages9
JournalJournal of Hypertension
Volume32
Issue number8
DOIs
Publication statusPublished - 2014

Fingerprint

Antihypertensive Agents
Drug Therapy
Drug Prescriptions
Hospitalization
Therapeutics
Population Density
Diuretics
Hypoglycemic Agents
Antidepressive Agents
Prescriptions
Demography
Databases
Delivery of Health Care
Kidney
Lung

Keywords

  • antihypertensive drugs
  • databases
  • discontinuation
  • persistence

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Factors involved in the discontinuation of antihypertensive drug therapy : An analysis from real life data. / Mancia, Giuseppe; Zambon, Antonella; Soranna, Davide; Merlino, Luca; Corrao, Giovanni.

In: Journal of Hypertension, Vol. 32, No. 8, 2014, p. 1708-1716.

Research output: Contribution to journalArticle

Mancia, Giuseppe ; Zambon, Antonella ; Soranna, Davide ; Merlino, Luca ; Corrao, Giovanni. / Factors involved in the discontinuation of antihypertensive drug therapy : An analysis from real life data. In: Journal of Hypertension. 2014 ; Vol. 32, No. 8. pp. 1708-1716.
@article{ae221b88ed5f4b2eb8ab4083fe4ff3f3,
title = "Factors involved in the discontinuation of antihypertensive drug therapy: An analysis from real life data",
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.",
keywords = "antihypertensive drugs, databases, discontinuation, persistence",
author = "Giuseppe Mancia and Antonella Zambon and Davide Soranna and Luca Merlino and Giovanni Corrao",
year = "2014",
doi = "10.1097/HJH.0000000000000222",
language = "English",
volume = "32",
pages = "1708--1716",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Factors involved in the discontinuation of antihypertensive drug therapy

T2 - An analysis from real life data

AU - Mancia, Giuseppe

AU - Zambon, Antonella

AU - Soranna, Davide

AU - Merlino, Luca

AU - Corrao, Giovanni

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - antihypertensive drugs

KW - databases

KW - discontinuation

KW - persistence

UR - http://www.scopus.com/inward/record.url?scp=84904038888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904038888&partnerID=8YFLogxK

U2 - 10.1097/HJH.0000000000000222

DO - 10.1097/HJH.0000000000000222

M3 - Article

C2 - 24842699

AN - SCOPUS:84904038888

VL - 32

SP - 1708

EP - 1716

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 8

ER -