Poor medication-taking behaviors are important considerations in the management of hypertension. The authors conducted a retrospective cohort study addressing antihypertensive drug persistence and compliance by linking four administrative databases and a province-wide clinical database in Ontario, Canada, to derive a cohort of elderly hypertensive patients, aged 66 years or more, who had received a new prescription for an antihypertensive agent between 1997 and 2005 to determine trends across years and associations with drug class and sociodemographic and other factors.

Their cohort consisted of 207,473 patients (58.4% were women, mean age 74.2 years, 73.1% were comorbid-free), 41,236 of whom had diabetes. Persistence and compliance increased between 1997 and 2005 (all P<.02) and were greater in those of higher socioeconomic status but lesser in urban residents (all P<.0001). Persistence was lower in comorbid-free patients and greater in older patients, whereas compliance was lower in older patients and greater in women and comorbid-free patients (all P<.0001). Significant differences between the drug classes emerged with initial prescriptions for all drug classes showing greater therapy and class persistence compared with diuretics (all P<.0001). Angiotensin-converting enzyme inhibitors showed the best therapy persistence and compliance, and beta-blockers showed the worst compliance (all P<.0001).

Their data provide evidence of an overall improvement in antihypertensive drug compliance and persistence across years, as well as significant differences across drug classes and other patient-level factors. Awareness of such factors could translate into concerted efforts at optimizing medication-taking behaviors among newly diagnosed elderly hypertensive patients.