New strategies needed for low medication persistence in severe hypertension, says study

New pharmacological and nonpharmacological management strategies should be implemented for people with severe hypertension, suggest the results of a study involving a large primary prevention population in France.

“Low medication persistence is reported in patients with severe hypertension, but few data are available according to drug classes,” the authors said.

Using the French national health data system, the authors identified adults without cardiovascular disease who initiated treatment, in a semester between 2010 and 2012, with two concurrent dispensations of at least three drug classes.

High persistence after 12 semesters of follow-up was defined by a 6-monthly mean of number of drug classes ≥80 percent.

A total of 576, 048 adults (mean age 65.3 years, 42 percent men) alive at 6 years were included in the study (three classes: 79 percent; four classes: 18 percent; five or more classes: 4 percent).

Of the participants, 72 percent had high persistence. In multivariate analysis of baseline factors, high persistence was negatively associated with female sex, extreme ages, living in an overseas department, at least one comorbidity, absence or frequent general practitioner consultations, and a cardiologist consultation.

The adjusted odds ratios (ORs) were low for dispensing of the following: angiotensin-converting-enzyme inhibitors (OR, 0.87, 95 percent confidence interval [CI], 0.8–0.95), other renin-angiotensin-system antagonists (OR, 0.91, 95 percent CI, 0.83–0.99), and a high number of classes (four classes: OR, 0.17, 95 percent CI, 0.15–0.19; five or more classes: OR, 0.06, 95 percent CI, 0.05–0.08).

On the other hand, there was an inverse association for diuretics (OR, 1.45, 95 percent CI, 1.33–1.59), calcium channel blockers (OR, 1.63, 95 percent CI, 1.50–1.79), beta-blockers (OR, 1.92, 95 percent CI, 1.76–2.1), and other antihypertensives (OR, 1.6, 95 percent CI, 1.5–1.8).

Notably, no significant association was noted for angiotensin II receptor blockers (OR, 1.0, 95 percent CI, 0.9–1.1).