Incidence of cardiovascular events in Italian patients with early discontinuations of antihypertensive, lipid-lowering, and antidiabetic treatments

BACKGROUND: Aim of the present investigation was to quantify the early discontinuation phenomenon in patients treated for hypertension, dyslipidemia or diabetes, and to assess their clinical characteristics and incidence of cardiovascular (CV) outcomes to see whether an incorrect diagnosis was involved or treatment continuation might have been indicated. METHODS: Using the health-care databases on beneficiaries of the National Health Service (NHS) living in Lombardy, we studied patients aged 40-79 years who received their first prescription during 2003. Patients were classified according to whether they received only one or multiple prescriptions and data were compared with those obtained in individuals who did not receive any prescription. Crude and standardized rates of hospitalization for CV outcomes were calculated from initial prescription until 2008. RESULTS: Among the 203,302 patients on antihypertensive therapy, those experiencing only one prescription (35.7%) showed significant higher rates of cotreatments, comorbidities, and CV hospitalization than those who did not receive antihypertensive medications. Standardized CV rates were respectively 40.0 and 37.8 events every 10,000 person-year at risk (+7%). Similar findings were obtained for antidiabetic or lipid-lowering medications for which the between-group difference in CV rate was even greater (+21% and +18% respectively). CONCLUSIONS: In general practice management of hypertension, dyslipidemia and diabetes is characterized by a high rate of treatment discontinuation. Patients who early discontinued had an unfavorable risk profile and a greater incidence of CV events than untreated patients. This suggests that they include candidates in whom treatment continuation is advisable