REAL-WORLD USE AND DISCONTINUATION OF HYPERTENSION THERAPIES: INSIGHTS FROM THE ENLIGHTN STUDY USING PRIMARY CARE DATA IN ITALY
Author(s)
Bianca Oresta, PhD1, Giovambattista Desideri, MD2, Andrea Marcellusi, PhD3, Serena Falato, MSc4, Federico Fratoni, MSc4, Francesca Daniel, MSc5, Daniela De Serio, MD1.
1AstraZeneca, BioPharmaceutical Medical, Milan, Italy, 2Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, 3University of Milan, Milano, Italy, 4IQVIA Real World Solutions, Milan, Italy, 5AstraZeneca, BioPharmaceuticals Market Access & Government Affairs, Milan, Italy.
1AstraZeneca, BioPharmaceutical Medical, Milan, Italy, 2Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, 3University of Milan, Milano, Italy, 4IQVIA Real World Solutions, Milan, Italy, 5AstraZeneca, BioPharmaceuticals Market Access & Government Affairs, Milan, Italy.
OBJECTIVES: This study aimed to characterize the use and discontinuation patterns of antihypertensive therapy (AHTs) in routine clinical practice.
METHODS: EnligHTN-IT is a retrospective study of adults (≥18 years) with coded hypertension (HTN; ICD-9 401-405) identified in an Italian primary care database. We describe baseline characteristics and starting treatments among an incident HTN cohort comprising patients newly diagnosed in 2018. Adherence and persistence over 12 months were evaluated for 14 selected AHT molecules or molecule combinations, initiated as first-line (1L) therapy, and for spironolactone, independently of treatment line.
RESULTS: In 2018, 29,629 incident HTN patients were identified (incidence rate: 3.7 per 100 person-years). Mean age was 61.9 ±14.1 years, 14,944 (50.4%) were females, and 4,735 (16.0%) patients had ≥2 comorbidities. Among 25,651 (86.6%) incident patients receiving ≥1 AHT during follow-up, approximately 60% initiated monotherapy, one third dual therapy, and a minority combinations of ≥3 molecules. Among 1L AHT single molecules, the mean proportion of days covered (PDC) ranged from 18% to 65%. Adherence was highest among patients receiving ramipril, losartan, and amlodipine. Notable differences were observed within the beta-blocker class, with substantially higher adherence for nebivolol (49%) than for bisoprolol (18%). Combination therapies were associated with improved adherence, achieving mean PDC values exceeding 60% for most of the combinations evaluated. Consistently, treatment continuity exceeded 200 days for most combination therapies, whereas it ranged from 40 to 220 days for monotherapies, with the shortest time to discontinuation observed for bisoprolol. Spironolactone, independently of treatment line, was associated with poor adherence (<20%) and persistence (50 days).
CONCLUSIONS: In this real-world cohort of incident HTN patients, AHTs were mainly initiated as monotherapy, despite guideline recommendations favouring combination therapy as 1L. Discontinuation of AHT was common, with poorer adherence and persistence observed for bisoprolol and spironolactone, highlighting drug-specific differences and opportunities to improve HTN management.
METHODS: EnligHTN-IT is a retrospective study of adults (≥18 years) with coded hypertension (HTN; ICD-9 401-405) identified in an Italian primary care database. We describe baseline characteristics and starting treatments among an incident HTN cohort comprising patients newly diagnosed in 2018. Adherence and persistence over 12 months were evaluated for 14 selected AHT molecules or molecule combinations, initiated as first-line (1L) therapy, and for spironolactone, independently of treatment line.
RESULTS: In 2018, 29,629 incident HTN patients were identified (incidence rate: 3.7 per 100 person-years). Mean age was 61.9 ±14.1 years, 14,944 (50.4%) were females, and 4,735 (16.0%) patients had ≥2 comorbidities. Among 25,651 (86.6%) incident patients receiving ≥1 AHT during follow-up, approximately 60% initiated monotherapy, one third dual therapy, and a minority combinations of ≥3 molecules. Among 1L AHT single molecules, the mean proportion of days covered (PDC) ranged from 18% to 65%. Adherence was highest among patients receiving ramipril, losartan, and amlodipine. Notable differences were observed within the beta-blocker class, with substantially higher adherence for nebivolol (49%) than for bisoprolol (18%). Combination therapies were associated with improved adherence, achieving mean PDC values exceeding 60% for most of the combinations evaluated. Consistently, treatment continuity exceeded 200 days for most combination therapies, whereas it ranged from 40 to 220 days for monotherapies, with the shortest time to discontinuation observed for bisoprolol. Spironolactone, independently of treatment line, was associated with poor adherence (<20%) and persistence (50 days).
CONCLUSIONS: In this real-world cohort of incident HTN patients, AHTs were mainly initiated as monotherapy, despite guideline recommendations favouring combination therapy as 1L. Discontinuation of AHT was common, with poorer adherence and persistence observed for bisoprolol and spironolactone, highlighting drug-specific differences and opportunities to improve HTN management.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD156
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)