Compliance and persistence with antihypertensives in the netherlands; a comparative analysis with specific focus on RAAS intervening agents

S. Vegter, S.T. Visser, C. Boersma, M.J. Postma

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    OBJECTIVES: Inaccurate use of chronic medication is associated with worse disease prognosis and high health care costs. Differences in drug prices might be outweighted by differences in costs due to compliance and persistence. The aim of this study was to investigate compliance and persistence with antihypertensive agents acting on the renin-angiotensin-aldosterone-system (RAAS). METHODS: A cohort study was conducted based on pharmacy dispensing records ( Subjects were included who initiated treatment with either ACE-inhibitors (ACEi) or angiotensin receptor blockers (ARBs) between 1999 and 2007. a standardized toolbox was used, Refill-Sequence analyses (RS) measured persistence; Proportion of Days Covered analyses (PDC) measured one-year compliance. Differences in persistence were adjusted for age, gender and time of treatment initiation. RESULTS: A total of 27,544 patients initiated treatment with ACEi; 8,649 patients initiated treatment with ARBs. Using a grace period of 60 days, persistence with ARBs was better compared to ACEi, adjusted HR: 0.90 (95%CI: 0.84-0.96). Using a PDC cutpoint of 80%, one-year compliance with ARBa was also better compared to ACEi, 83.9% vs. 86.3%, P <0.01. Within ACEi's, differences in persistence between drugs were small. Within ARBs, persistence with losartan or valsertan was higher compared to irbesartan or candesartan, adjusted HR: 0.82 (0.74-0.90). Compliance within ARBs however was similar for all drugs (P = 0.27). Results were consistent when other grace periods or PDC cutpoints were used. CONCLUSIONS: Chronic users of ARBs were more compliant and persistent compared to users of ACEi. Differences in persistence within ARBs might be due to differences in drug tolerability and safety, but also due to differences in drug indications. Further results will be presented further exploring these findings, as well as analyzing differences in persistence between branded versus generic ACEi.
    Original languageEnglish
    Pages (from-to)359
    Number of pages1
    JournalValue in Health
    Issue number7
    Publication statusPublished - 1-Nov-2010


    • antihypertensive agent
    • dipeptidyl carboxypeptidase inhibitor
    • angiotensin receptor antagonist
    • losartan
    • irbesartan
    • candesartan
    • Netherlands
    • human
    • patient
    • pharmacy
    • sequence analysis
    • gender
    • drug tolerability
    • safety
    • drug indication
    • prognosis
    • health care cost
    • renin angiotensin aldosterone system
    • cohort analysis
    • drug therapy

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