Persistence with treatment for hypertension in actual practice

Background: Despite the existence of efficacious medications, many patients in actual practice remain with uncontrolled hypertension. Randomized clini cal trials, cannot address this issue well given their highly restricted en vironment. This paper examines persistence with antihypertensive therapy am ong patients in actual practice. Methods: Cohort study of patients who received a diagnosis of hypertension and were treated between 1989 and 1994 identified through the Saskatchewan Health databases. Patients with concurrent diagnoses likely to affect initi al treatment choice were excluded. The resulting population of 79 591 subje cts was grouped into those with established hypertension (52 227 [66%]) and those with newly diagnosed hypertension (27 364 [34%]). The initial antihy pertensive prescription, subsequent changes in treatment and persistence wi th antihypertensive therapy were analysed. Results: Persistence with antihypertensive therapy decreased in the first 6 months after treatment was started and continued to decline over the next 4 years. Of the patients with newly diagnosed hypertension, only 78% persis ted with therapy at the end of 1 year, as compared with 97% of the patients with established hypertension (p < 0.001). Among those with newly diagnose d hypertension, older patients were more likely than younger ones to persis t, and women were more likely than men to persist (p < 0.001). Interpretation: This analysis of actual practice data indicates that barrie rs to persistence occur early in the therapeutic course and that achieving successful therapy when treatment is started is important to maintaining lo ng-term persistence.