Document Detail


A comparison between persistence to therapy in ALLHAT and in everyday clinical practice: a generalizability issue.
MedLine Citation:
PMID:  15057318     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Persistence to therapy was very high in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and was similar between treatment arms. Most patients were already on antihypertensive therapy before the trial began. Clinically, the results from this trial are more likely to be applied when antihypertensive therapy is initiated. OBJECTIVES: To assess whether the conclusions drawn from ALLHAT could be applied to the initiation of antihypertensive therapy. METHODS: A MEDLINE literature search was performed using the key words 'persistence', 'persistence to therapy', 'compliance' and 'adherence', and these were each linked with 'hypertension'. Studies from pharmaceutical databases were selected when they reported persistence to any antihypertensive therapy at one year according to which initial drug class (calcium channel blockers, angiotensin-converting enzyme inhibitors and thiazides) was initially prescribed. From the reported persistence rates, the number of patients was determined in whom treatment of hypertension results in a waste of health resources when each initial drug class was prescribed. RESULTS: Persistence to antihypertensive therapy at one year reported in the pharmaceutical databases varies from 5% to 75%. It was lower when the initial drug that was prescribed was a diuretic versus an angiotensin-converting enzyme inhibitor or a calcium channel blocker. The number of patients in whom treatment of hypertension resulted in a waste of resource was also higher when a diuretic was initially prescribed. CONCLUSION: Persistence to antihypertensive therapy is low for all the agents initiated and the lowest with diuretics. This should be considered as a word of caution when the ALLHAT conclusions are applied to the clinical setting.
Authors:
Héloise Cardinal; Amir Abbas Tahami Monfared; Marc Dorais; Jacques LeLorier
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  20     ISSN:  0828-282X     ISO Abbreviation:  Can J Cardiol     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-04-01     Completed Date:  2004-06-03     Revised Date:  2008-04-09    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  417-21     Citation Subset:  IM    
Affiliation:
Research Centre, Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal, Quebec.
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MeSH Terms
Descriptor/Qualifier:
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use*
Antilipemic Agents / therapeutic use*
Calcium Channel Blockers / therapeutic use
Follow-Up Studies
Humans
Myocardial Infarction / epidemiology,  prevention & control*
Physician's Practice Patterns*
Randomized Controlled Trials as Topic*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Antilipemic Agents; 0/Calcium Channel Blockers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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