OBJECTIVE: The aim of the study was to investigate gender differences in persistence with antihypertensive drugs (AHT). METHODS: Data for this study were obtained from the PHARMO system including pharmacy records and hospitalisations in the Netherlands (n = 950,000). Patients between 1997-2001 who newly received monotherapy of AHTs were selected. One-year persistence was defined as the percentage of patients using AHTs at least 270 days and receiving AHT in 3 months after the one-year follow-up period. Persistence was presented as one-year persistence (95%CI). Odds ratios (OR) were calculated with logistic regression and adjusted for age, use of antidiabetics and lipid lowering drugs, and prior cardiovascular hospitalizations. RESULTS: In the period 1997-2001, 17,113 patients newly received at least one AHT prescription with a follow-up >15 months. Of these patients, random samples of 500 patients per drug class were drawn. Persistence was highest in angiotensin II receptor blockers (ARBs) (62.1%), progressively lower in ACE-inhibitors (60.2%), betablockers (35.5%), calcium channel blockers (34.7%), and diuretics (33.0%), resulting in the highest OR of 3.3 [95%CI: 2.5-4.4] for ARBs compared to diuretics. The persistence of AHT use in women is substantially lower than in men (40.4% versus 50.3%, OR 0.7 [95%CI: 0.6-0.8]). CONCLUSIONS: These results demonstrate marked differences in persistence between AHT classes, with the highest persistence for ARBs and lowest for diuretics. Women were less persistent with their AHT compared to men. This low persistence leads to suboptimal treatment with substantial consequences. Especially in women, more improvement can be gained to improve their cardiovascular outcome.