Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, -Epidemiology & -Economics, Groningen, Netherlands.
Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Eur J Clin Pharmacol. 2022 Oct;78(10):1687-1696. doi: 10.1007/s00228-022-03369-0. Epub 2022 Aug 2.
Poor persistence to antihypertensive therapy is an important cause of treatment failure. Investigating persistence is especially important in countries with a high cardiovascular mortality, like Lithuania. The aim of this study was to describe the antihypertensive treatment at initiation, to determine the percentage of patients not being persistent with antihypertensive treatment after 1 year and to explore factors associated with non-persistence.
In this cohort study, data on dispensed prescription medicines from the Lithuanian National Health Insurance Fund (NHIF) were used. All adult patients with a diagnosis of hypertension having first antihypertensive dispensed in 2018 were included. Descriptive statistics was used to determine the number of patients started with monotherapy and combination therapy. Treatment choice by Anatomical Therapeutic Chemical (ATC) and number of active pharmaceutical ingredient (API) was described. Non-persistence was assessed using the anniversary method. Multivariate logistic regression was used to explore factors associated with non-persistence.
A total of 72,088 patients were included into the study, 56% started on monotherapy treatment, with 49% being dispensed an angiotensin converting enzyme inhibitor, and 44% started on combination therapy. Overall, 57% of patients were non-persistent after 1 year. Patients' gender and prescriber qualification showed no association with non-persistence. Younger patients, patients from rural area, patients started with monotherapy, and patients with no medication change had higher odds to become non-persistent.
The majority of patients were initiated with treatment following hypertension management guidelines, but it is of concern that over half of the patients were non-persistent to antihypertensive therapy in the first year.
降压治疗的持续性差是治疗失败的一个重要原因。在心血管死亡率较高的国家，如立陶宛，调查持续性尤为重要。本研究的目的是描述降压治疗的起始情况，确定 1 年后未坚持抗高血压治疗的患者比例，并探讨与不持续性相关的因素。
在这项队列研究中，使用了立陶宛国家健康保险基金（NHIF）的配药处方数据。纳入了所有在 2018 年首次开具降压药的成年高血压患者。采用描述性统计方法确定开始单药治疗和联合治疗的患者人数。按解剖治疗化学（ATC）和活性药物成分（API）数量描述治疗选择。使用周年法评估非持续性。采用多变量逻辑回归探索与非持续性相关的因素。
共纳入 72088 例患者，56%开始单药治疗，其中 49%接受血管紧张素转换酶抑制剂治疗，44%开始联合治疗。总体而言，1 年后 57%的患者不持续。患者性别和处方医生资格与非持续性无关。年轻患者、农村地区患者、开始单药治疗的患者和无药物改变的患者更有可能不持续。
大多数患者的治疗符合高血压管理指南，但令人担忧的是，超过一半的患者在第一年就不坚持抗高血压治疗。
