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Éric Tremblay
Mélanie Turgeon
Michel Gaudet
Line Guénette


Antihypertensive, guideline adherence, medication persistence, pharmacoepidemiology



Choosing the initial pharmacotherapy for new antihypertensive users and ensuring adherence to therapy can be problematic.


We sought to assess the quality of pharmacotherapy among new users of antihypertensives in Quebec, and to measure persistence with treatment in the short and longer term.


Using provincial administrative databases, a historical population-based study was conducted with a cohort of Quebec adults who filled their first antihypertensive prescription between January 1, 2007, and December 31, 2009. We described antihypertensive treatment for those with a diagnosis of hypertension (HTN) in the 5 years preceding initiation of drug therapy. Conformity with criteria for optimal use based on the 2006 Canadian Hypertension Education Program (CHEP) was evaluated. Persistence with treatment was estimated at 3 months, 1 year and 2 years after pharmacotherapy initiation.


Among the 79,181 new antihypertensive users with HTN who started treatment between 2007 and 2009, 82.5% were first prescribed only one drug, usually an angiotensin II receptor blocker or an angiotensin-converting enzyme inhibitor and rarely a diuretic. 24.2% of newly treated hypertensive persons aged 60 or older in our sample received a beta-blocker, which is not recommended practice. The initial treatment conformed to CHEP recommendations for 72.8% of those with uncomplicated HTN. After 3 months, 69.8% of new users still persisted with their treatment. This proportion remained stable after 1 year (69.1%) and 2 years (69.2%).


Conformity of antihypertensive treatment with CHEP criteria, and patient persistence with therapy, was fairly high for new users in the province of Quebec. Research is needed, however, on how to further improve pharmacotherapy quality and persistence in new users.

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1. Lawes CM, Vander Hoorn S, Law MR, et al. Blood pressure and the global burden of disease 2000. Part 11: estimates of attributable burden. J Hypertens 2006;24: 423 - 30.
2. Lawes CM, Vander Hoorn S, and Rodgers A. Global burden of blood - pressure-related disease, 2001. Lancet 2008;371: 1513 - 8.
3. Lee DS, Chiu M, Manuel DG, et al. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors. CMAJ 2009;181: E55 - 66.
4. Psaty BM, Lumley T, Furberg CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 2534 - 44.
5. Bourgault C, Rai nville B, Suissa S. Antihypertensive drug therapy in Saskatchewan: patterns of use and determinants in hypertension. Arch Intern Med 2001; 161:1873 - 9.
6. Cortez - Dias N, Martins S, Belo A, et al. Prevalence and management of hypertension in primary care in Port ugal. Insights from the VALSI M study. Rev Port Cardiol 2009;28: 499 - 523.
7. Hemmelgarn BR, Chen G, Walker R, et al. Trends in antihypertensive drug prescriptions and physician visits in Canada between 199 6 and 2006. Can J Cardiol 2008;24: 507 - 12.
8. Laplante P, Ni yonsenga T, Delisle E, et al. [Treatment patterns of hypertension in 1996. Data from the Quebec Family Practice, University of Sherbrooke reg istry]. Can Fam Physician 1998;44: 306 - 12.
9. McInnis NH, Fodor G, Lum - Kwong MM, et al. Antihypertensive medication use and blood pressure control: a community - based cross-sectional survey (ON - BP). Am J Hypertens 2008;21: 1210 - 5.
10. Perreault S, Lamarre D, Blais L, et al. Persistence with treatment in newly treated middle-aged patients with essential hypertension. Ann Pharmacother 2005; 39: 1401 - 8.
11. Lachaine J, Petrella RJ, Merikle E, et al. Choices, persistence and adherence to antihypertensive agents: evidence from RAMQ data. Can J Cardiol 2008;24: 269 - 73.
12. Bramlage P, Hasford J . Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment - - a review. Cardiovasc Diabetol 2009;8: 18.
13. Bourgault C, Senecal M, Brisson M, et al. Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study. J Hum Hypertens 2005;19: 607 - 13.
14. Khan NA, McAlister FA, Rabkin SW, et al. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 - Therapy. Can J Cardiol 2006;22: 583 - 93.
15. Hemmelgarn BR, McAlister FA, Grover S, et al. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 -- Blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol 2006;22: 573 - 81.
16. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285: 2370 - 5.
17. Tamblyn R, Lavoie G, Petrella L, et al. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995;48: 999 - 1009.
18. Wilchesky M, Tamblyn RM, Huang A. Validation of diagnostic codes within medical services claims. J Clin Epidemiol 2004;57: 131 - 41.
19. Institut national d'excellence en santé et en services sociaux (INESSS), Portrait de l’usage des antihypertenseurs chez les adultes assurés par le régime public d’assurance méd icaments du Québec. ETMIS 2012; 8/6.
20. Khan NA, Hemmelgarn B, Herman RJ, et al. The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 - therapy. Can J Cardiol 2009;25: 287 - 98.
21. Khan NA, Hemmelgarn B, Herman RJ, et al. The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. Can J Cardiol 2008; 24: 465 - 75.
22. Hoogwerf BJ. Renin - angiotensin system blockade and cardiovascular and renal protection. Am J Cardiol 2009 ;105: 30A - 5A.
23. Matchar DB, McCrory DC, Orlando LA, et al. Systematic review: comparative effectiveness of angiotensin - converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med 2008;148: 16 - 29.
24. Guidelines and Protocols Advisory Commitee (GPAC). Hypertension - Detection, Diagnosis and Management. 2008, Ministry of Health Services: Victoria, BC.
25. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289: 2560 - 72.
26. Institute for Clinical Systems Improvement (ICSI). Health care guideline: hypertension diagnosis and treatment. 2010, ICSI: Bloomington, MN.
27. Wright JM and Musini VM. First - line drugs for hypertension. Cochrane Database Syst Rev 2009: CD001841.
28. Musini VM, Tejani AM, Bassett K, et al. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev 2009: CD000028.
29. National Institute for Health and Clinical Excellence (NICE). Hypertension: management of hypertension in adults in primary care (quick reference guide). 2006, NICE: Manchester, UK.
30. National Institute for Health and Clinical Excellence (NICE). Hypertension: clinical management of primary hypertension in adults (quick reference guide). 2011, NICE: Manchester, UK.
31. Guertin JR, Jackevicius CA, Cox JL, et al. The potential economic impact of restricted access to angiotensi n - receptor blockers. CMAJ 2011;183: E180 - 6.
32. Institut national d'excellenc e en santé et en services sociaux (INESSS). Des indicateurs de qualité à l’intention des professionnels et des gestionnaires des services de première ligne. 2012, INESSS: Montréal, Qc.
33. Friedman O, McAlister FA, Yun L, et al. Antihypertensive drug persisten ce and compliance among newly treated elderly hypertens ives in Ontario. Am J Med 2010;123: 173 - 81.
34. Muhajarine N, Mustard C, Roos LL, et al. Comparison of survey and physician claims data for detecting hypertension. Journal of Clinical E pidemiology 1997;50: 7 11 - 8.
35. Suissa S, Garbe E. Primer: administrative health databases in observational studies of drug effects -- advantages and disadvantages. Nature clinic al practice. Rheumatology 2007;3: 725 - 32.
36. Blais L, Lemiere C, Menzies D, et al. Validity of asthma diagnose s recorded in the Medical Services database of Quebec. Pharmacoepidemiol Drug Saf 2006;15: 245 - 52.