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| |  ESH: Long-Term Compliance to Losartan Superior To Other Antihypertensives By Bruce Wilson Special to DG News
MILAN, ITALY -- June 20, 2001 -- More patients remained on antihypertensive therapy with losartan compared to four other classes of medication in a four-year study presented at the 11th European Society of Hypertension meeting. Although many first-line antihypertensives are highly effective at controlling blood pressure, patients are often noncompliant due to a number of factors, such as side effects, dosing regimens, cost, and other factors. A substantial number of newly diagnosed hypertensive patients discontinue therapy within the first year of treatment, previous research has found. Studies have shown that patient compliance with the newer antihypertensive agents, such as antiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and the angiotensin II receptor antagonists (AIIAs), is better than with beta-blockers and diuretics, possibly due to improved tolerability. To study this further, a United States group of investigators conducted a retrospective cohort analysis of a large managed care pharmacy administration claims database to determine how many patients receiving antihypertensive medication stayed on their therapy and how many stopped. They looked at a four-year time period between 1996 and 2000. The study population consisted of a cohort of 15,175 patients, 69 percent of whom were less than 65 years of age. Initial medication consisted of an AIIA (losartan, 3 percent), ACE inhibitor (29.2 percent), calcium channel blocker (CCB, 25.6 percent), beta-blocker (25.1 percent), and a diuretic (17.1 percent). At 12 months, a greater percentage of patients stayed on therapy for the AIIA class (67.4 percent) compared to the ACE inhibitors (60.7 percent), CCBs (54.1 percent), beta-blockers (45.6 percent), or diuretics (20.8 percent). The difference between the AIIA and all other classes was statistically significant (p<0.01). At 48 months, more than half of the patients initially treated with the AIIA, losartan, were receiving their initial antihypertensive class (50.9 percent), compared to ACE inhibitors (46.5 percent), CCBs (40.7 percent), beta-blockers (34.7 percent), and diuretics (16.4 percent). The difference between the AIIA and all classes except the ACE inhibitors was statistically significant (p<0.01). Most striking was the observation that most patients who stopped taking their medication did so within the first six months after their therapy began. The authors admitted that the study was limited by several factors. For example, utilization of cardiovascular medications was not linked to medical diagnosis, there was no control for severity of disease (number of medications or concomitant disease), the prescriber specialty information was not evaluated, and no patient-related information was evaluated (i.e. efficacy or tolerability data). Nevertheless, the authors concluded that, within the limitations of this study, more patients appear to stay on initial therapy with the AIIA, losartan, than with any other class of antihypertensive.
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