BMJ 1995;311:293-295 (29 July)

General practice

Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population

J K Jones, president,a L Gorkin, senior projects manager,a J F Lian, epidemiology project manager,a J A Staffa, epidemiologist,a A P Fletcher, medical director b

a The Degge Group, 1616 North Fort Myer Drive, Suite 1430, Arlington VA 22209, USA, b IMS International, London

Correspondence to: Dr Jones.

Abstract

Objective: To evaluate the incidence of discontinuation of and changes in treatment after newly prescribed courses of antihypertensive drugs of the four primary therapeutic classes: ß blocker, calcium channel blocker, and angiotensin converting enzyme inhibitor.
Design: A retrospective analysis of patients on an automated database of 1.2 million patients was conducted on visits between 1 October 1992 and 30 September 1993.
Setting: General practices in the United Kingdom.
Subjects: 37643 patients with hypertension receiving a relevant drug in the time period were identified. A new course of treatment in at least one of the four therapeutic classes, defined as a drug not prescribed in the previous four months, was observed in 10222 patients aged >/=40 years.
Main outcome measures: Patients changing to other treatment or discontinuing after initiating a new course of treatment, defined as the absence of a refill prescription for the new drug or another in its category within a six month observation period.
Results: Changes in or discontinuation of treatment were frequently observed, and by month six continuation rates ranged between 40% to 50% for all four classes of drugs.
Conclusion: Low rates of continuation with a newly prescribed antihypertensive drug exist regardless of which drug is prescribed.

Key messages

  • Key messages

  • Up to half of new courses of treatment studied were changed or discontinued treatment over six months

  • Patients were more likely to switch to a different class of drug rather than to a different drug within the same class

  • The recommended step by step treatment for hypertension did not seem to be followed

  • Research on why so many patients discontinue treatment is indicated


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