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Table 1 Overview of studies on compliance / persistence with treatment

From: Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment – a review

a – Studies on compliance/persistence with treatment (Part 1)

References

Database

Study design

Definitions

Patients

Baseline

Bloom 1998 [15]

USA

21,723 pts.

Bloom cohort study, longitudinal database with pharmacy administrative claims [15]

Retrospective, longitudinal cohort study

1 year follow-up

Persistence: at least 3 refills over 1 year

Switch: no initial AH drug but other AH

Discontinued: ≤ 2 refills

Patients with initiation on antihypertensive monotherapy, and no treatment within the 12 month before

Mean age: 56 y

Male: 44.1%

Initial drug class:

ARBs: 2.6%

ACEi: 26.9%

CCBs: 23.4%

BBs: 23.0%

Diuretics: 24.1%

Rizzo 1996 [27]

USA

Pts. not available

National Medical Expenditure Survey 1987

Retrospective, longitudinal cohort study

1 year follow-up

not available

Patients with chronic illnesses including hypertension

Age range 18–64 y

Rizzo 1997 [25]

USA

7,211 pts.

Pennsylvania Medicaid Management Information System

Retrospective, longitudinal cohort study

1 year follow-up

Compliance: estimated

Patients with a treatment for hypertension (monotherapy)

Mean age: 59.4 y

Male: 29%

Initial drug class:

ACEi: 32%

CCBs: 49%

BBs: 11%

Diuretics: 8%

Hughes 1998 [26]

UK

7,741 pts.

MEDIPLUS database

Retrospective, longitudinal cohort study

26 months follow-up

Persistence: patients continuing therapy at 6 months

Patients with new antihypertensive treatment

Not available

Conlin 2001 [18]

USA

15,175 pts.

Bloom cohort study, longitudinal database with pharmacy administrative claims [15]

Retrospective, longitudinal cohort study

1 + 3 year follow-up

Persistence: at least 3 refills over 1 year

Switch: no initial AH drug but other AH

Discontinued: ≤ 2 refills

Patients with initiation on antihypertensive monotherapy, and no treatment within the 12 month before

Mean age: 56 y

Male: 45%

Initial drug class:

ARBs: 3.0%

ACEi: 29.2%

CCBs: 25.6%

BBs: 25.1%

Diuretics: 17.1%

Hasford 2002 [36]

Germany, France, UK

2,416 pts.

IMS MediPlus

Retrospective, longitudinal cohort study

1 year follow-up

Persistence: 4 refills over 1 year

Switch: no initial AH drug but other AH

Discontinued: stopped refill for at least 30 days after medication ran out

Patients with initiation on antihypertensive monotherapy, no previous treatment

Mean age: 61

Male: ~50%

Initial drug class:

ARBs: 31.2%

ACEi: 13.8%

CCBs: 19.3%

BBs: 18.3%

Diuretics: 17.5%

Degli Esposti 2001

Italy

4,614 pts.

Local Health Unit of Ravenna

Retrospective, longitudinal cohort study

 

Patients with a first prescription for amlodipine, atenolol fosinopril, indapamide or losartan

 

Degli Esposti 2002 [22]

Italy

7,312 pts.

Local Health Unit of Ravenna

Retrospective, longitudinal cohort study

3 year follow-up

Continuers (persistence): at least 2 prescriptions per year over 3 years

Discontinuers: at least 2 prescriptions per year for the first year only or and the second year but not in the third year

Patients with new antihypertensive drug treatment

Mean age: ~63 y

Male: 43.1

Initial drug class:

ARBs: 2.7%

ACEi: 33.1%

CCBs: 25.7%

BBs: 15.9%

Diuretics: 22.6%

b – Studies on compliance/persistence with treatment (Part 2)

References

Database

Study design

Definitions

Patients

Baseline

Degli Esposti 2004 [23]

Italy

14,062 pts.

Local Health Unit of Ravenna

Prospective, longitudinal cohort study

1 year follow-up

Persistence: therapy duration of > 273 days.

Patients with new antihypertensive drug treatment

Mean age: 56.9 y

Male: 43.4%

Initial drug class:

ARBs: 6.9%

ACEi: 28.0%

CCBs: 23.8%

BBs: 17.6%

Diuretics: 23.8%

Erkens 2005 [37]

Netherlands

2,243 pts.

PHARMO database including pharmacy records and hospitalisation

Retrospective, longitudinal cohort study

1 year follow-up

Persistence: drugs for at least 270 d and 3 month after the 1 year follow-up

Switch: no initial AH drug but other AH

Discontinued: stopped refill for at least 30 days after medication ran out

Patients with initiation on antihypertensive monotherapy, no previous treatment

Mean age: most pts. (42.6%) 40–59 y

Male: 43.1%

Initial drug class:

ARBs: 19.9%

ACEi: 18.4%

CCBs: 20.3%

BBs: 21.0%

Diuretics: 20.4%

Sokol

2005 [24]

USA

7,981 pts.

Participants of a medical and drug benefit plan sponsored by a large manufacturing employer

Retrospective, longitudinal cohort study

1 year follow-up

Adherence was defined as the percentage of days during the analysis period that patients had a supply of 1 or more maintenance medications for the condition (based on "days' supply" data in patients' prescription claim records).

Patients being on the respective treatment for at least 12 months.

Mean age: 54.2 y

Male: 53.3%

Veronesi

2007 [19]

Italy

347 pts.

Outpatients of a hypertension clinic

Prospective, longitudinal, single-blind, cohort study

2 year follow-up

Persistence: continued use of the initial AH over time

Patients with initiation on antihypertensive monotherapy, no antihypertensive treatment in the last 6 month

Mean age: 59.4 y

Male: 59.4%

Initial drug class:

ARBs: 15.2%

ACEi: 17.5%

CCBs: 18.1%

BBs: 17.5%

Diuretics: 18.1%

Hasford 2007 [17]

Germany

13,763 pts.

IMS disease analyse database

Retrospective, longitudinal cohort study

3 year follow-up

Persistence: continued treatment over time

Discontinuation: no repeat AH drug prescription for more than 6 month

Patients with initiation on antihypertensive monotherapy or a specified combination, no antihypertensive treatment in the last 6 month

Median age: 65 y

Male: 44.2%

Initial drug class:

ARBs: 5.4%

ACEi: 21.0%

CCBs: 11.8%

BBs: 37.3%

Diuretics: 14.5%

Patel

2007 [16]

USA

242,882 pts.

Administrative pharmacy claims from MedImpact

Retrospective, longitudinal cohort study

1 year follow-up

Persistence: continued treatment over time

Discontinuation: no refill for 60 days after running out of pills

Patients with initiation on antihypertensive monotherapy

Median age: 54.5 y

Male: 43.1%

Initial drug class:

ARBs: 4.2%

ACEi: 32.4%

CCBs: 14.9%

BBs: 34.1%

Diuretics: 14.4%

  1. ARBs, Angiotensin receptor blockers; ACEi, Angiotensin converting enzyme inhibitor; CCBs, calcium channel blockers; BBs, Beta-blockers; y, years