Persistence with antihypertensive treatments: results of a 3-year follow-up cohort study

Eur J Clin Pharmacol. 2007 Nov;63(11):1055-61. doi: 10.1007/s00228-007-0340-2. Epub 2007 Aug 14.


Objective: Effective treatment of hypertension requires continued prescribing of antihypertensive medications for many years. Persistence in prescribing habits, however, has been reported to be low. The study described herein - which is completely independent of pharmaceutical sponsors - was undertaken to evaluate persistence with antihypertensive treatment in Germany.

Methods: A total of 13,763 newly diagnosed hypertensive patients were identified in the IMS Disease Analyzer database and observed for 3 years after their first antihypertensive prescription.

Results: The median age of the study cohort was 65 years, and 56% were female. One in four patient received no more than three prescriptions within 3 years. Persistence was longest for patients whose initial prescription was for a free combination based on angiotensin converting enzyme inhibitors (median: 392.5 days), followed patients initially receiving a fixed combination, including angiotensin II receptor antagonists (208.5 days) and AIIRA monotherapy (168 days). Persistence was shortest with diuretics (57 days). Across all treatment groups, persistence after 3 years was 15.2%. Insurance status, sex and comorbidities were not found to impact persistence.

Conclusion: Our data indicate that persistence differs markedly among the drug classes (p < or = 0.001) but that even persistence of the best drug class is not sufficient to provide for an adequate blood pressure control in the population. The largest decline in persistence occurred in the first 3 months of treatment. More research is needed to elucidate the causes of this early drop in persistence and to develop effective means of improving the currently unsatisfactory situation.

MeSH terms

  • Aged
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Germany
  • Humans
  • Hypertension / drug therapy*
  • Insurance Coverage
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Sex Factors
  • Time Factors


  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Drug Combinations