Persistence and compliance with newly initiated antihypertensive drug treatment in patients with chronic kidney disease

Viet Thanh Truong,1,2 Jocelyne Moisan,1,2 Edeltraut Kröger,1–3 Serge Langlois,4 Jean-Pierre Grégoire1,2 1Faculty of Pharmacy, Laval University, 2Chair on Adherence to Treatments, Population Health and Optimal Practices in Health Research Unit, CHU de Québec Research Center, 3Center of Excellence on Aging of Québec, 4Faculty of Medicine, Laval University, Quebec, Canada Background: Patients with chronic kidney disease initiating an antihypertensive drug (AH) treatment must persist and comply with it to slow disease progression and benefit from the reduction of cardiovascular morbidity and mortality. Objectives: This study evaluates the persistence and compliance with AH treatment and identifies the associated factors among chronic kidney disease patients who initiated AH treatment. Methods: A population-based cohort study using Quebec administrative data was conducted. Patients who still take any AH 1 year after initiation were considered persistent. Of these patients, those who had ≥80% of days covered with an AH in the year after initiation were considered compliant. Factors associated with persistence and compliance were identified using a modified Poisson regression. Results: Of the 7,119 eligible patients, 78.8% were persistent, 87.7% of whom were compliant with their AH treatment. Compared with patients on diuretic monotherapy, those who initially used angiotensin-converting enzyme inhibitor monotherapy, angiotensin II receptor blocker monotherapy, calcium channel blocker monotherapy, β-blocker monotherapy, or multidrug therapy were more likely to be persistent. In contrast, individuals who visited their physicians ≥17 times were less likely to be persistent than those who visited between 0 and 8 times. The patients who were more likely to be compliant had initially used an angiotensin-converting enzyme inhibitor, β-blocker, calcium channel blocker, or multitherapy as opposed to a diuretic. Conclusion: A year after initiating AH treatment, nearly a third of chronic kidney disease patients were either not taking an AH or had not been compliant. Factors associated with persistence and compliance could help identify patients who need help in managing their AH treatment. Keywords: chronic kidney disease, adherence, factors, antihypertensive dru