A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice

Maddalena Veronesi, Arrigo FG Cicero, Maria Grazia Prandin, Ada Dormi, Eugenio Cosentino, Enrico Strocchi, Claudio Borghi

D. Campanacci Clinical Medicine and Applied Biotechnology Department Alma Mater Studiorum University of Bologna, Italy

Abstract: Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 ± 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), ß-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), β-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, β-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (–11.2/–5.8 mmHg), ACE inhibitors (–10.5/–5.1 mmHg), and CCBs (–8.5/–4.6 mmHg) compared with ß-blockers (–4.0/–2.3 mmHg p < 0.05) and diuretics (–2.3/–2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, β-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.

Keywords: hypertension, antihypertensive drugs, persistence, blood pressure