Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario

Background — Poor medication-taking behaviors are important considerations in the management of hypertension.

Methods — We conducted a retrospective cohort study addressing antihypertensive drug persistence and compliance by linking 4 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.

Results — Our 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).

Conclusion — Our 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.