A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice

Abstract

Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.

Figure 1

Rate of persistence on treatment after 6,12, and 24 months in different subgroups of patients treated with angiotension-II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), lercanidipine, ß-blockers, and diuretics. *, **, ***p < 0.05, 0.01, 0.005 vs ARBs.

Figure 2

Systolic blood pressure decrease over 24 months in the overall population of patients (n = 347) initially allocated to the different classes of antihypertensive drugs. *p < 0.05 vs other drug classes. Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin-II receptor blockers; CCBs, calcium channel blockers.

Figure 3

Systolic blood pressure decrease over 24 months in the selected population of patients allocated to different drug classes and not replacing the antihypertensive treatment after withdrawal. *p < 0.05 vs other drug classes. Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin-II receptor blockers; CCBs, calcium channel blockers.