Pharmacoeconomic Analysis of Antihypertensive Medication Persistence

Study Population and Methodology

An aggregate of 19,995 subjects were taken on the review. Of these, 5933 subjects (29.7% of enrollees) were excluded: 3673 (18.4% of enrollees) because they were taking a class of medication excluded from the review, 1443 (7.2% of enrollees) due to joining several medication classes, 480 (2.4% of enrollees) due to death, and 337 (1.7% of enrollees) because they moved away during the follow-up period.

A total of 14,062 patients were included in the study, 6098 men (43.4%) and 7964 women (56.6%) with a mean age of 56.9±17.7 years (range 20-105 years). ACE inhibitors were the most commonly prescribed medication (28.0%), followed by CCBs (23.8%), diuretics (23.8%), β-blockers (17.6%), and AIIAs (6.9%).

Treatment Persistence Results

Within the population, 60.3% of patients discontinued treatment, 30.9% continued treatment, and 8.8% switched treatment. Among those who discontinued, 83.3% interrupted the treatment after a single prescription. Among the continuers, 81.1% maintained their enrollment treatment throughout the follow-up period without switching. The rates of continuers, switchers, and discontinuers varied significantly among the five medication classes (p<0.001).

Persistence with therapy was related to age (each year of age decreased the risk of discontinuation by 2.2%), coronary heart disease or diabetes (subjects not treated for these showed a higher risk of stopping), hospitalization history for cardiovascular disease, comorbidities, and the antihypertensive class prescribed at enrollment.

Patients starting on AIIAs were more likely to remain on treatment compared to those on ACE inhibitors (38.6% higher discontinuation risk), CCBs (66.3% higher risk), and diuretics (85.3% higher risk). Gender and the use of anti-asthmatic drugs were not significantly associated with treatment persistence.

Cost Analysis Findings

The total cost for the study cohort was €1,238,752.37, of which €745,328.31 was for continuers (60.2%), €253,293.08 for switchers (20.4%), and €240,130.98 for discontinuers (19.4%). The average yearly cost per patient was €88.09 (95% CI, €86.10–€90.08). The cost varied significantly based on the medication class and persistence patterns (p<0.001).

The annual cost of antihypertensive treatment was associated with age (each year reduced the cost by €0.43), persistence patterns (switchers incurred €33.17 higher costs than continuers), and the number of drug classes prescribed (each additional class increased the cost by €10.94).

Patients who began treatment with diuretics had lower annual costs compared to those starting on β-blockers (€67.45 more), ACE inhibitors (€168.20 more), CCBs (€188.84 more), and AIIAs (€278.19 more).

Hypertension (High Blood Pressure)

Hypertension is a common chronic condition that can cause other health issues such as cardiac disease.

Symptoms

Hypertension is often asymptomatic, even at extreme levels. Common symptoms include headaches, shortness of breath, nosebleeds, and tinnitus. However, many patients with poorly controlled hypertension show no symptoms.

Monitoring Blood Pressure

Blood pressure can be checked routinely during medical visits. If you are 40 years or older or have a family history of hypertension, regular monitoring is advised. Home monitoring devices are also available.

Types of Hypertension

Primary (Essential) Hypertension

Develops gradually over many years with no identifiable cause.

Secondary Hypertension

Caused by underlying conditions such as hormonal imbalances, kidney issues, or lifestyle factors like smoking and alcohol abuse.

Risk Factors

Risk increases with age, particularly after 45. Hypertension is more common in men, but the risk for women rises after menopause. People of African origin are more prone to hypertension.

Other Risk Factors

• Family History: Hypertension can have a genetic link.
• Body Mass Index (BMI): Overweight individuals are more likely to develop hypertension.
• Inactive Lifestyles: Sedentary habits increase the risk of high blood pressure.
• Smoking: Both direct and secondhand smoke raise blood pressure.
• Sodium Intake: Excessive salt leads to fluid retention, increasing blood pressure.
• Potassium: Low potassium levels can also cause blood pressure fluctuations.
• Alcohol: Excessive drinking affects blood pressure regulation.

Complications

• Heart Attacks: A known complication of hypertension.
• Strokes: Hypertension increases the risk of cerebrovascular accidents.

Understanding Blood Pressure

What is Blood Pressure?

Blood pressure is the force exerted by the blood against the walls of the arteries. It is measured in millimeters of mercury (mm Hg). The ideal blood pressure range for adults is typically between 110/70 mm Hg and 125/80 mm Hg. A reading of 140/90 mm Hg is considered high, especially as people age.

How Blood Pressure Works

Blood does not circulate in a continuous flow; instead, it travels in spurts. The pressure peaks in the blood vessels just after a heartbeat and ebbs until the next one. This process is ongoing, reflecting the heart's pumping action.

The two numbers in a blood pressure reading represent the pressures during heartbeats (systolic) and when the heart is at rest (diastolic). The strength of the arteries affects blood pressure—stiffer arteries can lead to higher blood pressure.

Factors Affecting Blood Pressure

As a person ages, the elasticity of their arteries may weaken, often resulting in higher blood pressure readings. However, the diastolic pressure (the lower number) should remain under 90, at least until a person reaches their sixties.

Research indicates a higher prevalence of hypertension in Black individuals compared to White individuals. This disparity may be influenced by socioeconomic and health factors, necessitating further investigation.

Types of Hypertension

Some individuals with high blood pressure may not identify a specific cause; they may be fit and lead a healthy lifestyle, yet their blood pressure remains high. This condition is known as Primary or Essential Hypertension. Conversely, if high blood pressure is due to an underlying medical condition, it is referred to as Secondary Hypertension.

© 2024 Health Insights