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Persistence and adherence to antihypertensive treatment in relation to initial prescription: diuretics versus other classes of antihypertensive drugs

Trimarco, Valentinaa; de Simone, Giovannic; Izzo, Raffaeleb; De Luca, Nicolab; Giudice, Renatab; Marino, Marinab; Damiano, Silviac; Rozza, Francescob; Trimarco, Brunob; Di Renzo, Gianfrancoa

doi: 10.1097/HJH.0b013e328353398b
ORIGINAL PAPERS: Therapeutic aspects

Background: The use of thiazide diuretics in the treatment of hypertension is widely considered as a first-line treatment, given the efficacy and low cost of this class of drugs. This indication is not unanimous, because thiazides can cause metabolic alterations, and other side effects that reduce compliance and persistence on treatment.

Objectives: In a multicentre, open-label randomized study we compared adherence and persistence to therapy of chlortalidone versus other treatments, as a first-line antihypertensive therapy.

Methods: Ninety-two general practitioners (GPs) recruited 2409 hypertensive patients with indication to antihypertensive therapy, who were randomized in two arms to start treatment with chlortalidone (12.5–25 mg daily) or any other single medications (excluding thiazides). The patients have been followed for at least 2 years.

Result: Patients receiving diuretic therapy as first-line antihypertensive treatment, modified antihypertensive treatment regimen more often than the others (79.1 versus 43.9%; χ2 < 0.0001). Patients starting with diuretics received greater number of drugs, compared to patients starting with different antihypertensive therapy (1.55 versus 1.4 antihypertensive drugs; P < 0.0001), but achieved the same blood pressure (BP) control during the follow-up. No differences were observed in persistence and adherence to treatment between the two groups.

Conclusion: Our results demonstrate that the recommendation to start antihypertensive therapy with diuretics, when no compelling indications are present, is not supported by the evidence that this strategy produces more rapid and better control of BP.

aDepartment of Neurosciences

bDepartment of Clinical Medicine, Cardiovascular and Immunological Sciences

cDepartment of Clinical and Experimental Medicine, Federico II University, Naples, Italy

Correspondence to Bruno Trimarco, MD, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy (Via Sergio Pansini 5, bld 2 – 80131 Naples). Tel: +39 081 7462250; fax: +39 081 7462256; e-mail:

Abbreviations: BP, blood pressure; CRF, Case Report Form; CSN, Campania Salute Network; GP, general practitioner; HR, heart rate; Meds, medicines

Received 20 October, 2011

Revised 18 January, 2012

Accepted 2 March, 2012

© 2012 Lippincott Williams & Wilkins, Inc.