Corrao Giovanni, Zambon Antonella, Parodi Andrea, Poluzzi Elisabetta, Baldi Ileana, Merlino Luca, Cesana Giancarlo, Mancia Giuseppe
Department of Statistics, Unit of Biostatistics and Epidemiology, University of Milano-Bicocca, Milan, Italy.
J Hypertens. 2008 Apr;26(4):819-24. doi: 10.1097/HJH.0b013e3282f4edd7.
To assess rates and determinants of treatment discontinuation of or changes in initial antihypertensive drug therapy in a large cohort of patients from Lombardia (Italy).
The cohort included 445356 patients aged 40 -80 years who received their first antihypertensive drug prescription (monotherapy) during 1999--2002. Discontinuation was defined by the absence of any antihypertensive prescription during a 90-day period following the end of the latest prescription. If during the same period a drug of a different class was added or replaced the initial prescription, treatment modification was regarded as combination or switching, respectively. Competing risks methodology was used to estimate and compare cause-specific cumulative incidence.
Cumulative incidences of discontinuation, combination and switching were respectively 33, 14 and 15% at 6 months, 41, 18 and 17% at 1 year, and 50, 25 and 19% at 5 years since initial treatment. Compared with patients starting treatment with angiotensin-converting enzyme inhibitors, the rate of discontinuation was less for patients on angiotensin receptor blockers with a hazard ratio of 0.92 (95% confidence interval =0.90-0.94), whereas increased discontinuation was observed for patients starting with other drugs, mainly beta-blockers with a hazard ratio of 1.64 (1.62-1.67); and diuretics with a hazard ratio of 1.83 (1.81-1.85).
In the general population of Lombardia, discontinuation of the initial single antihypertensive drug treatment is a common phenomenon, whereas switching to another monotherapy and to combination treatment occur at similarly much lower rates. Blockers of the renin-angiotensin system are associated with the lowest incidence of treatment discontinuation.
评估意大利伦巴第大区一大群患者中初始抗高血压药物治疗停药率及改变情况的发生率和决定因素。
该队列包括445356名年龄在40 - 80岁之间的患者，他们在1999 - 2002年期间接受了首张抗高血压药物处方（单一疗法）。停药定义为在最后一张处方结束后的90天内没有任何抗高血压药物处方。如果在同一时期添加了不同类别的药物或替换了初始处方药物，则治疗改变分别视为联合治疗或换药。采用竞争风险方法来估计和比较特定病因的累积发病率。
自初始治疗起，停药、联合治疗和换药的累积发病率在6个月时分别为33%、14%和15%，1年时分别为41%、18%和17%，5年时分别为50%、25%和19%。与开始使用血管紧张素转换酶抑制剂治疗的患者相比，使用血管紧张素受体阻滞剂的患者停药率较低，风险比为0.92（95%置信区间=0.90 - 0.94），而开始使用其他药物（主要是β受体阻滞剂，风险比为1.64（1.62 - 1.67）；利尿剂，风险比为1.83（1.81 - 1.85））的患者停药率增加。
在伦巴第大区的普通人群中，停用初始单一抗高血压药物治疗是一种常见现象，而换用另一种单一疗法和联合治疗的发生率则低得多。肾素 - 血管紧张素系统阻滞剂的治疗停药发生率最低。
