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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