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Persistence to antihypertensive drug treatment in Swedish primary healthcare

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

To determine factors associated with low persistence in patients initiated on drug treatment for hypertension.

Methods

Cohort study using medical records for patients with hypertension in 48 Swedish primary healthcare centres. Data were linked to national registers on dispensed drugs, hospitalizations, outpatient hospital consultations, deaths, migration, and socioeconomy. We identified 5225 patients (55 % women, mean age 61 years) initiated on antihypertensive drug treatment during 2006–2007. Persistence was measured for two years by the dispensed drugs. Patients with a gap of >30 days between end of dispensed supply and the next dispensed prescription were classified as non-persistent. This was calculated by Kaplan–Meier analysis. Cox proportional hazard regression was used to estimate hazard ratios for discontinuation. Potential predictors included age, gender, blood pressure before initiation of therapy, cardiovascular comorbidity, educational level, country of birth, and income.

Results

Among patients with a dispensed first prescription, 26 % discontinued treatment during the first year, and a further 9 % discontinued during the second year. Discontinuation (all adjusted) was more common in men (P = 0.002) and in younger patients (30–49 years, P < 0.001). Systolic (P < 0.001) but not diastolic blood pressure was positively associated with persistence. Native-born Swedish citizens and patients born in the other Nordic countries had lower discontinuation rates than those born outside the Nordic countries (P < 0.001).

Conclusion

Major determinants of discontinuation of antihypertensive drug treatment are male sex, young age, mild-to-moderate systolic blood pressure elevation, and birth outside of Sweden.

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Acknowledgments

This study was funded by the Swedish Heart Lung Foundation, the Drug and Therapeutics Committee of Stockholm County Council, Karolinska Institutet, the Health & Medical Care Committee of the Regional Executive Board of the Region Västra Götaland, and the Skaraborg Research and Development Council. The SPCCD is endorsed by the Swedish Society of Hypertension, Stroke, and Vascular Medicine.

Declaration of interest

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Solna, Karolinska Institutet, Centre for Pharmacoepidemiology, T2, Karolinska University Hospital, SE-171 76, Stockholm, Sweden

    Miriam Qvarnström, Helle Kieler, Lena Brandt & Björn Wettermark

  2. Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden

    Thomas Kahan

  3. Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Centre for Family and Community Medicine, Stockholm, Sweden

    Jan Hasselström

  4. R&D Centre Skaraborg Primary Care, Skövde, Sweden

    Kristina Bengtsson Boström & Per Hjerpe

  5. Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Karin Manhem

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  1. Miriam Qvarnström
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  2. Thomas Kahan
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Correspondence to Miriam Qvarnström.

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Qvarnström, M., Kahan, T., Kieler, H. et al. Persistence to antihypertensive drug treatment in Swedish primary healthcare. Eur J Clin Pharmacol 69, 1955–1964 (2013). https://doi.org/10.1007/s00228-013-1555-z

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