Van Wijk Boris Lg, Klungel Olaf H, Heerdink Eibert R, de Boer Anthonius
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, The Netherlands.
J Hypertens. 2005 Nov;23(11):2101-7. doi: 10.1097/01.hjh.0000187261.40190.2e.
To assess the proportion of patients starting with antihypertensive drug treatment who continued treatment for at least 10 years.
A retrospective cohort study.
The PHARMO record linkage system containing drug dispensing records from community pharmacies and linked hospital discharge records of approximately 950 000 subjects.
Patients who started using antihypertensive drugs (two or more prescriptions) in 1992 and did not receive a prescription for any antihypertensive drug in the 365 days preceding the first prescription.
Persistence with antihypertensive drugs until 10 years.
Among a total of 2325 patients who started using antihypertensive drugs, 39% used continuously during the 10 years of follow-up. Approximately 22% temporarily discontinued and restarted treatment, whereas 39% of patients discontinued permanently. Older patients were more persistent than younger patients [20-39 years: odds ratio (OR) 2.08; 95% confidence interval (CI) 1.52-2.84; 40-59 years: (reference), > or = 60 years: OR 0.69; 95% CI 0.54-0.89]. More patients who started with diuretics (reference) and beta blockers (OR 1.15; 95% CI 0.87-1.52) discontinued compared with those who started with dihydropyridine calcium antagonists (OR 0.54; 95% CI 0.34-0.84), and angiotensin-converting enzyme (ACE) inhibitors (OR 0.38; 95% CI 0.27-0.55). Patients who started with combination therapy (OR 0.29; 95% CI 0.14-0.54 compared with diuretics) or patients who were initially treated by a cardiologist (OR 0.82; 95% CI 0.61-0.97) or internist (OR 0.80; 95% CI 0.62-0.98 compared with general practitioners) also showed higher persistence.
Long-term persistence in daily practice is low compared with persistence observed in randomized clinical trials and should be considered in the choice of a first-line antihypertensive agent.
评估开始接受抗高血压药物治疗并持续治疗至少10年的患者比例。
一项回顾性队列研究。
PHARMO记录链接系统，包含社区药房的药品配药记录以及约950,000名受试者的医院出院记录。
1992年开始使用抗高血压药物（两张或更多处方）且在首张处方前365天内未接受任何抗高血压药物处方的患者。
抗高血压药物持续使用至10年。
在总共2325名开始使用抗高血压药物的患者中，39%在10年随访期间持续用药。约22%的患者暂时停药后又重新开始治疗，而39%的患者永久停药。老年患者比年轻患者更具持续性[20 - 39岁：比值比（OR）2.08；95%置信区间（CI）1.52 - 2.84；40 - 59岁：（参考），≥60岁：OR 0.69；95% CI 0.54 - 0.89]。与开始使用二氢吡啶类钙拮抗剂（OR 0.54；95% CI 0.34 - 0.84）和血管紧张素转换酶（ACE）抑制剂（OR 0.38；95% CI 0.27 - 0.55）的患者相比，开始使用利尿剂（参考）和β受体阻滞剂（OR 1.15；95% CI 0.87 - 1.52）的患者停药的更多。开始联合治疗的患者（与利尿剂相比，OR 0.29；95% CI 0.14 - 0.54）或最初由心脏病专家治疗的患者（OR 0.82；95% CI 0.61 - 0.97）或内科医生治疗的患者（与全科医生相比，OR 0.80；95% CI 0.62 - 0.98）也表现出更高的持续性。
与随机临床试验中观察到的持续性相比，日常实践中的长期持续性较低，在选择一线抗高血压药物时应予以考虑。
