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Drug adherence in treatment resistant and in controlled hypertension - Results from the Swedish Primary Care Cardiovascular Database (SPCCD)

Journal article
Authors Lina Holmqvist
K. B. Bostrom
T. Kahan
Linus Schiöler
M. Qvarnstrom
B. Wettermark
P. Hjerpe
J. Hasselstrom
Karin Manhem
Published in Pharmacoepidemiology and Drug Safety
Volume 27
Issue 3
Pages 315-321
ISSN 1053-8569
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 315-321
Language en
Keywords drug adherence, hypertension, pharmacoepidemiology, primary care, treatment resistant hypertension, blood-pressure control, medication adherence, hypertensive patients, renal denervation, persistence, therapy, Public, Environmental & Occupational Health, Pharmacology & Pharmacy
Subject categories Pharmaceutical pharmacology, Community medicine


Purpose To assess drug adherence in patients treated with 3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Methods Patients with hypertension, without cardiovascular comorbidity, aged >30years treated with 3 antihypertensive drug classes were followed for 2years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level80% were included. Results We found 5846 patients treated 3 antihypertensive drug classes, 3508 with TRH (blood pressure140/90), and 2338 with controlled blood pressure (<140/90mmHg). TRH patients were older (69.1 vs 65.8years, P<.0001) but had less diabetes (28.5 vs 31.7%, P<.009) compared with patients with controlled blood pressure. The proportion of patients with PDC80% declined with 11% during the first year in both groups. Having diabetes was associated with staying adherent at 1year (RR 0.82; 95% CI, 0.68-0.98) whilst being born outside Europe was associated with nonadherence at one and (RR 2.05; 95% CI, 1.49-2.82). ConclusionsPatients with multiple antihypertensive drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment.

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