Van Wijk Boris L G, Klungel Olaf H, Heerdink Eibert R, de Boer Anthonius
Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
Pharmacoepidemiol Drug Saf. 2006 Aug;15(8):587-93. doi: 10.1002/pds.1239.
Discontinuation with treatment is a major problem in the treatment of hypertension. The objective of our study was to assess the association between non-compliance and discontinuation in patients who started using antihypertensive monotherapy.
A nested case-control study within a cohort of new users of antihypertensive drugs between 1st January 1999 and 31st December 2002 was performed. We used data from the PHARMO database, a record linkage system containing drug-dispensing records from community pharmacies and linked hospital discharge records of approximately 950,000 subjects. Cases discontinued their use of antihypertensive monotherapy and were not switched to other antihypertensive treatment, controls stayed on their initially prescribed monotherapy. Conditional logistic regression was used to calculate odds ratios (OR) and their 95% confidence intervals (CI).
In a cohort of 39,714 new users of antihypertensive drugs, we identified 9111 cases and 9111 matched controls. The percentage of non-compliant patients (compliance < 80%) among cases and controls was 14.0% and 5.8%, respectively [OR 2.86 (95%CI: 2.52-3.24)]. Patients who used less than 90 days had a higher risk on discontinuation [OR 3.10 (95%CI: 2.67-3.59)] than patients who used more than 90 days [OR 2.28 (95%CI: 1.79-2.92)]. The association was generally similar among males and females, among the different types of antihypertensives and among the different age groups.
In patients who start antihypertensive monotherapy, non-compliance is often followed by discontinuation of this antihypertensive treatment. The pharmacy medication history is a valuable tool for physicians to identify patients who have a high risk on discontinuation with antihypertensive treatment.
在高血压治疗中，中断治疗是一个主要问题。我们研究的目的是评估开始使用抗高血压单一疗法的患者中不依从性与治疗中断之间的关联。
在1999年1月1日至2002年12月31日期间新使用抗高血压药物的队列中进行了一项巢式病例对照研究。我们使用了PHARMO数据库中的数据，这是一个记录链接系统，包含社区药房的药物配药记录以及约950,000名受试者的关联医院出院记录。病例停止使用抗高血压单一疗法且未改用其他抗高血压治疗，对照继续使用最初规定的单一疗法。采用条件逻辑回归计算比值比（OR）及其95%置信区间（CI）。
在39,714名新使用抗高血压药物的队列中，我们确定了9111例病例和9111名匹配对照。病例组和对照组中不依从患者（依从性<80%）的百分比分别为14.0%和5.8%[OR 2.86（95%CI：2.52 - 3.24）]。使用少于90天的患者比使用超过90天的患者有更高的治疗中断风险[OR 3.10（95%CI：2.67 - 3.59）]对比[OR 2.28（95%CI：1.79 - 2.92）]。在男性和女性、不同类型的抗高血压药物以及不同年龄组中，这种关联总体上相似。
在开始抗高血压单一疗法的患者中，不依从性之后通常会中断这种抗高血压治疗。药房用药史是医生识别有抗高血压治疗中断高风险患者的宝贵工具。
