Choice of initial antihypertensive drugs and persistence of drug use-a 4-year follow-up of 78,453 incident users

European Journal of Clinical Pharmacology, 04/12/2012

Thiazides (TZs) and angiotensin II–receptor blockers (ARBs) were the most widely used first–line antihypertensives. Among the men enrolled in the study, ARB users had a somewhat better persistence with antihypertensive treatment than TZ users. Among both genders, continuation on ARBs was more common than continuation on TZs.


  • All initial users of antihypertensive drugs in 2005 and 2009 registered in the Norwegian Prescription Database were included.
  • Treatment on five index dates at 1–year intervals was recorded.
  • A patient was considered to be under treatment on an index date if a drug had been dispensed within the previous 180 days and to have maintained treatment persistence if he/she was on any antihypertensive treatment on the index date and all previous index dates.


  • Among 78,453 new users of antihypertensives in 2005, women started more often with TZs than men (30 vs. 25 %) and less often with ARBs (22 vs. 25 %).
  • In men, the hazard of non–persistence with antihypertensive treatment was significantly lower among initial ARB users than among TZ users (hazard ratio 0.87, 95 % confidence interval 0.81–0.94); in women no significant difference was found.
  • After 4 years, 49 % of the men and 51 % of the women who had started with plain TZs were still using TZs, whereas 65 % of the male ARB users and 60 % of the female ARB users were still using ARBs.

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