Costa Francesco Vittorio, Degli Esposti Luca, Cerra Carlo, Veronesi Chiara, Buda Stefano
Madre Fortunata Toniolo Hospital, Bologna, Italy.
High Blood Press Cardiovasc Prev. 2009 Dec;16(4):167-76. doi: 10.2165/11530410-000000000-00000. Epub 2013 Jan 3.
To assess trends in prescriptions, determinants and timing of treatment discontinuation and/or changes in antihypertensive drug therapy in a cohort of hypertensive patients living in Pavia, a city in the north of Italy.
The cohort included 61 493 patients aged ≥18 years who received their first antihypertensive drug prescription (monotherapy, fixed or extemporaneous combination) during the period 2003-6. Patients were classified as 'persistent' if 12 months after the beginning of treatment they were still taking a regular therapy (same drug = 'same therapy users', added one or more drugs = 'add-on therapy users', different drug = 'switchers'). Otherwise, they were classified as 'non-persistent' (stopping therapy after the first prescription = 'occasional users'; stopping treatment early = 'stoppers'; taking medicines in an erratic fashion = 'intermittent users').
ACE inhibitors were the most frequently prescribed drugs (22.8%), followed by β-adrenoceptor antagonists (β-blockers) [14.3%], diuretics (13.9%), Ca(2+) antagonists (11.4%) and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) [9.3%]. After 12 months, persistent patients were only 11.2% (same therapy users 6.7%, switchers 3.2%, add-on therapy users 1.3%). Non-persistent patients were 88.8% (35.3% occasional users, 20.6% stoppers, 32.8% intermittent users). Patient-related predictors of persistence were older age, male sex, concomitant treatment with antidiabetic and hypolipidaemic drugs and previous hospitalizations for cardiovascular events. Highest level of persistence was seen in patients starting with ARBs (18.8%), followed by ACE inhibitors (11.4%), β-blockers (11.0%), Ca(2+) antagonists (10.8%) and diuretics (3.0%). Among ARBs, considering separately monotherapy and fixed-combination therapy, highest level of persistence was observed in patients starting with candesartan, irbesartan, valsartan and telmisartan given in monotherapy, and with valsartan and telmisartan given in fixed-dose combination.
Persistence to antihypertensive treatment at 12 months is only 11.2%, being the lowest with diuretics (3.0%) and the highest with ARBs (18.8%).
评估居住在意大利北部城市帕维亚的一组高血压患者的降压药物治疗处方趋势、治疗中断和/或改变的决定因素及时间。
该队列包括61493名年龄≥18岁的患者，他们在2003年至2006年期间接受了首张降压药物处方（单一疗法、固定或临时联合用药）。如果患者在治疗开始12个月后仍在接受常规治疗（使用相同药物 = “相同疗法使用者”，添加一种或多种药物 = “附加疗法使用者”，更换药物 = “换药者”），则被分类为“持续治疗者”。否则，他们被分类为“非持续治疗者”（首次处方后停止治疗 = “偶尔使用者”；提前停止治疗 = “停药者”；不规则服药 = “间歇使用者”）。
血管紧张素转换酶（ACE）抑制剂是最常处方的药物（22.8%），其次是β-肾上腺素能受体拮抗剂（β受体阻滞剂）[14.3%]、利尿剂（13.9%）、钙（Ca2+）拮抗剂（11.4%）和血管紧张素II 1型受体拮抗剂（血管紧张素受体阻滞剂[ARBs]）[9.3%]。12个月后，持续治疗的患者仅占11.2%（相同疗法使用者6.7%，换药者3.2%，附加疗法使用者1.3%）。非持续治疗的患者占88.8%（偶尔使用者35.3%，停药者20.6%，间歇使用者32.8%）。与患者相关的持续治疗预测因素包括年龄较大、男性、同时接受抗糖尿病和降血脂药物治疗以及既往因心血管事件住院。起始使用ARBs的患者持续治疗率最高（18.8%），其次是ACE抑制剂（11.4%）、β受体阻滞剂（11.0%）[、Ca2+拮抗剂（10.8%）和利尿剂（3.0%）。在ARBs中，分别考虑单一疗法和固定联合疗法，起始使用坎地沙坦、厄贝沙坦、缬沙坦和替米沙坦单一疗法以及缬沙坦和替米沙坦固定剂量联合疗法的患者持续治疗率最高。
12个月时抗高血压治疗的持续率仅为11.2%，利尿剂的持续率最低（3.0%），ARBs的持续率最高（18.8%）。
