Choi Yun Jung, Ah Young-Mi, Kong Jisun, Choi Kyung Hee, Kim Baegeum, Han Nayoung, Yu Yun Mi, Oh Jung Mi, Shin Wan Gyoon, Lee Hae-Young, Lee Ju-Yeun
College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi, South Korea.
College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
Cardiovasc Ther. 2016 Aug;34(4):268-75. doi: 10.1111/1755-5922.12197.
Potential heterogeneity within the same class of drug in terms of persistence may lead to different clinical implications. Given that the increased risks of mortality and cardiovascular events are due, in part, to the lack of persistent use of antihypertensive medications, the objective of this study was to evaluate 1-year persistence of new-generation beta blockers compared to atenolol in antihypertensive treatment-naïve patients.
A total of 9978 patients aged 18 years or older with hypertension newly diagnosed in 2012, without hypertension-related complication and initiated treatment with beta blocker monotherapy during 2012 were included in the analysis. Rate and duration of treatment and drug persistence were compared between atenolol and new-generation beta blockers. Hazards of discontinuation in nonatenolol compared to atenolol were evaluated using a multivariate Cox proportional model.
The rate of treatment persistence was higher in the nonatenolol group (57.35% vs 53.40%, P<.0001), and the time to treatment discontinuation was earlier in the atenolol group with a minimal difference in the average (243.2 vs 254 days, P<.0001). New-generation beta blockers demonstrated a lower risk of treatment discontinuation (HR: 0.91, 95% CI: 0.86-0.96) compared to atenolol; a notable improvement was observed with carvedilol and nebivolol (HR: 0.74, 95% CI: 0.69-0.80 and HR: 0.79, 95% CI: 0.70-0.89, respectively), whereas betaxolol showed a substantially greater hazard for discontinuation compared to atenolol.
This study demonstrated a meaningful improvement in treatment persistence with new-generation beta blockers compared to atenolol, with betaxolol as exception.
同一类药物在持续性方面潜在的异质性可能导致不同的临床意义。鉴于死亡率和心血管事件风险增加部分归因于抗高血压药物持续使用不足，本研究的目的是评估初治高血压患者中新一代β受体阻滞剂与阿替洛尔相比的1年持续性。
纳入分析的患者共9978例，年龄在18岁及以上，于2012年新诊断为高血压，无高血压相关并发症，并于2012年开始接受β受体阻滞剂单药治疗。比较阿替洛尔与新一代β受体阻滞剂的治疗率、治疗持续时间和药物持续性。使用多变量Cox比例模型评估非阿替洛尔与阿替洛尔相比的停药风险。
非阿替洛尔组的治疗持续性率更高（57.35%对53.40%，P<0.0001），阿替洛尔组的治疗停药时间更早，平均差异最小（243.2天对254天，P<0.0001）。与阿替洛尔相比，新一代β受体阻滞剂的治疗停药风险更低（HR：0.91，95%CI：0.86 - 0.96）；卡维地洛和奈必洛尔有显著改善（HR分别为：0.74，95%CI：0.69 - 0.80和HR：0.79，95%CI：0.70 - 0.89），而与阿替洛尔相比，倍他洛尔的停药风险显著更高。
本研究表明，与阿替洛尔相比，新一代β受体阻滞剂在治疗持续性方面有显著改善，但倍他洛尔除外。
