Quality of Life and Antihypertensive Drug Therapy

Joel Handler, MD

In This Article

Adherence to Therapy

In a large study evaluating refill persistence in almost 80,000 patients over 4 years, there was a difference in adherence between established and newly diagnosed hypertensive patients (Figure 9).[42] There was a steep drop-off of prescription refills for newly diagnosed hypertensive individuals, and at the end of 12 months, refill persistence was 78% for the newly diagnosed patients vs. 97% for the established group ( p <0.001). Often, this drop-off is attributed to side effects of medication, although issues surrounding the behavior change of taking pills for a minimally symptomatic condition also play a role. This observation may be important in view of the results from the recently reported Valsartan Antihypertensive Long-term Use Evaluation (VALUE) study,[43] largely because of the BP difference. In this trial, a difference in BP in the first 6- 12 months translated into increased MIs and strokes in patients whose BPs were lowered less than the other group. If newly diagnosed patients are not filling their prescriptions, they are at increased risk.

Cumulative rates of refill persistence for 79,591 Canadian patients with antihypertensive therapy for established and newly diagnosed hypertensive patients; 12 months, p<0.001 (97% vs. 78%). Reprinted with permission from CMAJ. 1999;160:31-37.[42]

The adverse-effect dropout rates were similar in the CCB and the ARB arms of the VALUE trial. In the CCB arm, patients dropped out because of edema. In the ARB arm, a statistically similar number of patients dropped out because of headache and dizziness.[43]