Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice

Giovanni Corrao, Andrea Parodi, Antonella Zambon, Franca Heiman, Alessandro Filippi, Claudio Cricelli, Luca Merlino, Giuseppe Mancia

Research output: Contribution to journalArticlepeer-review


Objectives: To measure persistence with antihypertensive drug therapy in patients initiating treatment with mono or combination therapy. Methods: Data analysis was based on two cohorts of patients, that is, a cohort derived from the registration of drug prescriptions in all residents of the Lombardy region receiving Public Health Service and a cohort of patients followed by general practitioners throughout the Italian territory. Data were limited to patients aged 40-80 years who received their first antihypertensive drug prescription (n = 433680 and 41199, respectively) in whom persistency of treatment was examined over 9 months. A proportional hazards model was fitted to estimate the association between the pattern of initial antihypertensive drug therapy and risk of treatment discontinuation. Data were adjusted for available potential confounders. Results: Taking patients starting with diuretic monotherapy as reference, the adjusted risk of treatment discontinuation was progressively lower in patients starting with monotherapy other than a diuretic, a two-drug combination, including a diuretic and a two-drug combination without a diuretic. No significant difference in the risk of discontinuation was seen between extemporaneous and fixed dose combinations, including a diuretic, that is, the only combination reimbursable by Public Health Service and, thus, available in the database. Data were similar for the two cohorts. Conclusion: Initiating treatment with a combination of two drugs is associated with a reduced risk of treatment discontinuation.

Original languageEnglish
Pages (from-to)1584-1590
Number of pages7
JournalJournal of Hypertension
Issue number7
Publication statusPublished - Jul 2010


  • antihypertensive agents
  • claims database
  • defined daily dose
  • medical records
  • persistence
  • treatment discontinuation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Internal Medicine


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