OBJECTIVES: Despite the proven efficacy of antihypertensive drugs (antiHTN) on morbidity and mortality, the extent of undertreatment and non-persistence is extremely high, hampering their effectiveness in real-life. In order to assess drug utilization patterns of newly treated hypertensive patients, we estimated the one-year risk of stopping initial treatment, the frequency of patients requiring add-on or switch therapy with other antiHTN. METHODS: A retrospective cohort study was conducted using Health Search Database that provided data by 320 Italian general practitioners. All newly-diagnosed hypertensive patients aged ≥ 35 years, who received antiHTN during the first three months after diagnosis were identified and were categorized into one of the following groups: 1) Continuers: patients continuing the first class of antiHTN; 2) Combiners: patients receiving an add-on with another class; 3) Switchers: patients changing from the first medication to another type of antiHTN; and 4) Discontinuers: patients stopping the first type therapy. RESULTS: Overall, among 13,303 new hypertensives, 19.8% were continuers, 22.1% combiners, 15.5% switchers, and 42.6% discontinuers. The highest proportion of continuers was found for persons starting with angiotensin-II antagonists (ARB's) (25.2%), calcium-antagonists (CCB's) (23.9%), and ACE-inhibitors (23.3%). Starting on diuretics was associated with the highest risk of discontinuing treatment, while the lowest risk was associated with starting on ARB's (Hazard Ratio [HR]: 0.43; 95% Confidence Interval (CI): 0.40-0.47), ACE-inhibitors (HR: 0.50; CI: 0.47-0.53) and CCB's (HR: 0.55; CI: 0.52-0.59). The risk of receiving add-on therapy was associated with a longer duration of therapy. Patients starting with alfa-blockers had the highest risk of switching therapy (HR: 0.50; CI: 0.47-0.53), while patients starting on ARB's (HR: 0.51; CI: 0.42-0.62) or ACE-inhibitors (HR: 0.60; CI: 0.52-0.69) had the lowest risk. CONCLUSIONS: In this cohort the persistence to initial antiHTN is rather low and the need to combine several drugs is often required.