Abstract
Purpose
To study drug persistence for antihypertensive treatment considering typical patient behaviour including extended drug holidays or irregular repeat prescriptions.
Methods
We used prescription data from a German statutory health insurance to follow up patients for 4 years. Medication persistence was defined as the continued use of a specific drug class, therapy persistence as the continued use of any antihypertensive drug. We applied 2 different interval criteria within which a repeat prescription had to be issued: 180 and 360 days.
Results
A total of 9,513 patients started an antihypertensive therapy between 2006 and 2008. Applying the 180-day (360-day) interval criterion, 28 % (66 %) of the patients starting therapy with a beta-blocker were still medication-persistent after 4 years. The rates were similar for angiotensin-II receptor blockers (ARBs; 30 % and 69 % respectively) or angiotensin-converting enzyme (ACE) inhibitors (28 % and 61 % respectively). Looking at therapy persistence, these rates were 44 % (79 %) when an ACE inhibitor was the initial drug, 46 % (82 %) for ARBs. On average, even of those who were defined as therapeutically persistent with the 360 days criterion, half received a repeat prescription within 96 days, three quarters within 131 days—with a median supply of 1.2 units per day and 1.25 defined daily doses.
Conclusion
By applying more patient-orientated criteria, we found that many patients were therapy-persistent and received a prescription at the appropriate time. Therapy persistence was nearly independent of the initial agent; thus, drug persistence may not be an argument in favour of choosing a certain drug as a first-line option.
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Acknowledgements
We are indebted to the AOK Nordost for permission to perform this study. Critical discussions with Stephanie Heinemann, MPH, helped to create order in the chaos of the data jungle.
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The paper is not under consideration by another journal and none of the results presented here have been published previously. Both authors fulfil the criteria for authorship and give their consent to publication.
There are no conflicts of interest.
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Ethical approval was not necessary owing to the nature of the data (secondary data analysis of anonymised files).
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Grimmsmann, T., Himmel, W. Persistence of antihypertensive drug use in German primary care: a follow-up study based on pharmacy claims data. Eur J Clin Pharmacol 70, 295–301 (2014). https://doi.org/10.1007/s00228-013-1607-4
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DOI: https://doi.org/10.1007/s00228-013-1607-4