(99) The Initiation of Treatment and One-Year Treatment Non-Persistence Rates in Hypertensive Patients in Lithuania

Publication Number: 773

Background: There is extensive evidence on benefits of antihypertensive treatment, yet many patients with hypertension do not reach therapy goals. Poor persistence to antihypertensive drug therapy has shown to be an important reason behind treatment failure. No studies on adherence and persistence have been conducted in Lithuania, despite that the country is among those with the highest cardiovascular mortality in Europe.

Objectives: To describe the choice of therapy for initiation of antihypertensive treatment, to determine the percentage of patients not being persistent with antihypertensive treatment after one year and to explore factors associated with non-persistence.

Methods: In this cohort study, data on dispensed prescription medicines from Lithuanian National Health Insurance Fund (NHIF) were used. All prescriptions of hypertensive adult patients that claimed their first prescription in 2018 were included. Initiation of treatment was described by ATC class for monotherapy patients and number of active pharmaceutical ingredients for combination therapy patients. Descriptive statistics were used to present means and frequencies. Non-persistence was assessed using anniversary method at day 365. Multivariate logistic regression was used to explore factors associated with non-persistence.

Results: 72088 patients with the diagnosis hypertension (mean age 58 years) received an antihypertensive treatment for the first time in 2018. Of those, 56% started with monotherapy treatment, 49% of them started with angiotensin converting enzyme inhibitors. 44% started with combination therapy. Of combination therapy patients 72% started with two active pharmaceutical ingredients. 57% of patients had discontinued the antihypertensive therapy after one year. 61% of monotherapy patients were non-persistent comparing to 53% of combination therapy patients. Patients gender and prescriber qualification showed no association with persistence. Younger patients, patients whose primary care registration was in rural area, patients started with monotherapy and patients with no medication change had higher odds to become non-persistent.

Conclusions: More than half of hypertensive patients were initiated with monotherapy treatment in 2018. More than half of all patients initiated on antihypertensive therapy discontinued the treatment within one year.