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Discontinuation with new antihypertensive and lipid lowering therapy

Clinical bottom line

When patients are prescribed antihypertensive and lipid lowering therapy, two thirds stop taking both medicines by six months.


Background

Long-term adherence and persistence with antihypertensive and lipid lowering therapy are poor. About 15% of prescriptions written are never filled, and about 13% of those written and filled are never taken. Thereafter adherence falls.

Reference

RH Chapman et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Archives of Internal Medicine 2005 165: 1147-1152.


Study

This was a retrospective analysis of people enrolled in a US managed care organisation from 1996 to 2001. From a computerised database, anonymised records of people prescribed antihypertensive and lipid-lowering medicine for the first time within a 90-day period formed the cohort for study.

The outcome was the adherence of both medicines, and each separately, over a follow up period as long as four years.

Considerable information, including demographic and medical history was available on each patient.

Results

There were 8,406 patients concomitantly prescribed antihypertensive and lipid lowering therapy, mostly (70% within 30 days of one another. Half the patients were over 65 years, and half were women.

Adherence to both medicines was below 50% by three months, and barely a third of patients were still adherent at six and 12 months (Figure 1). About 5% of patients were taking only lipid lowering therapy and about 20% only antihypertensive medicines, and the pattern was relatively unchanged out to 36 months.

Figure 1: Adherence to both antihypertensive and lipid lowering therapy

Patients were more likely to be adherent of they were taking fewer medicines, , were aged 55 to 64 years, and were men.

Comment

Starting patients on both antihypertensive medicines and lipid lowering medicines together is a good strategy, but poor adherence limits its practical effects.