Basic Clin Pharmacol Toxicol. 2026 Sep;139(3):e70286. doi: 10.1111/bcpt.70286.
ABSTRACT
AIM: To estimate persistence with antihypertensive therapy (AHT) and describe treatment changes and associated factors among persistent patients over 5 years.
METHODS: We conducted a longitudinal cohort study using the IADB.nl pharmacy database in the Netherlands, including adults who initiated AHT between 2014 and 2018 after a 2-year washout. Persistence was assessed annually using a ±45-day window around each treatment anniversary. Among patients persistent throughout follow-up, treatment changes were classified yearly as no change, switching, intensification or de-intensification. A Markov model estimated transitions between treatment states, and logistic regression evaluated baseline factors associated with treatment changes.
RESULTS: Among 22 027 starters (mean age 58.1 years, 51.1% women), annual persistence declined from 88.8% in year 1 to 80.7% in year 5, with 52.7% remaining persistent over 5 years. Treatment changes were most frequent in the first year, when 53.5% of persistent patients underwent intensification, de-intensification, or switching, and declined thereafter. The probability of remaining in the same state was high, particularly for 'no change' state (0.86). Female sex, combination therapy initiation and initiating on beta-blockers or calcium-channel blockers were associated with treatment changes.
CONCLUSION: Antihypertensive pharmacotherapy is frequently modified early after initiation, followed by increasing long-term treatment stability among persistent users.
PMID:42595960 | DOI:10.1111/bcpt.70286