Li Xuechun, Tia Mutiara Djayanis, Bos Jens H J, Schuiling-Veninga Catharina C M, Hak Eelko, Mubarik Sumaira
PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
J Hypertens. 2025 Sep 1;43(9):1519-1528. doi: 10.1097/HJH.0000000000004084. Epub 2025 Jun 20.
Real-world long-term adherence and drug utilization patterns are essential for hypertension management. However, the evidence was unclear. We aimed to construct adherence and drug patterns risk prediction models.
We designed a retrospective inception cohort study using pharmacy records from the University of Groningen IADB.nl dispensing database. Exposures were antihypertensive drug monotherapy including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, and thiazides. Primary outcomes included adherence rates and drug utilization patterns. Cluster analysis was performed to categorize patients with similar risk factors. Least Absolute Shrinkage and Selection Operator logistic regression was then employed to construct prediction models.
The adherence rate in the 1 st year to the 10 th year increased from 86.4% to 92.9%. Most monotherapies, middle and older age, with initial diabetes, asthma/ chronic-obstructive-pulmonary-disease drug, and without psycholeptics drug, first exposure prescription after 2000 promoted high adherence. Thiazides and being male were harmful to continuation and helpful to discontinuation, switching and adding on. Middle and older age promoted switching and adding on but impeded discontinuation. High adherence contributed to continuation, switching and adding on but impeded discontinuation. Thiazides were better for the short term use to achieve high adherence while calcium channel blockers in both short term and long term were better to achieve high adherence than beta-blockers.
The results highlighted key factors influencing medication adherence and treatment changes, emphasizing the need for personalized approaches to optimize patient care. Enhancing adherence and provide specific monotherapy for short term and long term plan were beneficial to better personalized treatment.
现实世界中的长期依从性和药物使用模式对高血压管理至关重要。然而，证据尚不清楚。我们旨在构建依从性和药物模式风险预测模型。
我们设计了一项回顾性队列研究，使用格罗宁根大学IADB.nl配药数据库中的药房记录。暴露因素为抗高血压药物单药治疗，包括血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂、β受体阻滞剂、钙通道阻滞剂和噻嗪类药物。主要结局包括依从率和药物使用模式。进行聚类分析以对具有相似危险因素的患者进行分类。然后采用最小绝对收缩和选择算子逻辑回归构建预测模型。
第1年至第10年的依从率从86.4%提高到92.9%。大多数单药治疗、中老年、初始患有糖尿病、哮喘/慢性阻塞性肺疾病药物治疗且无精神药物治疗、2000年后首次暴露处方可促进高依从性。噻嗪类药物和男性不利于持续用药，但有助于停药、换药和加药。中老年有利于换药和加药，但阻碍停药。高依从性有助于持续用药、换药和加药，但阻碍停药。噻嗪类药物短期使用更有利于实现高依从性，而钙通道阻滞剂在短期和长期都比β受体阻滞剂更有利于实现高依从性。
结果突出了影响药物依从性和治疗变化的关键因素，强调了采用个性化方法优化患者护理的必要性。提高依从性并为短期和长期计划提供特定的单药治疗有利于更好地进行个性化治疗。
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