Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Women discontinue antihypertensive drug therapy more than men. Evidence from an Italian population-based study

Rea, Federicoa,b; Mella, Martab; Monzio Compagnoni, Matteoa,b; Cantarutti, Annaa,b; Merlino, Lucac; Mancia, Giuseppea,d,e; Corrao, Giovannia,b

doi: 10.1097/HJH.0000000000002222

Objective: Several factors affect adherence to antihypertensive drug treatment, but whether these factors include a sex difference is unclear. Aim of the study was to compare persistence with antihypertensive drug therapy between men and women in a large cohort of patients.

Methods: The 60 526 residents of the Italian Lombardy Region aged 40–80 years newly treated with antihypertensive drugs during 2010 were identified and followed for 1 year after the first prescription. Discontinuation of treatment was defined as lack of prescription renewal for at least 90 days. Log-binomial regression models were fitted to estimate the risk ratio of treatment discontinuation in relation to sex. Other than for the whole population, analyses were stratified according to age, comorbidity status and the initial antihypertensive treatment strategy.

Results: Thirty-seven percent of the patients discontinued the drug treatment during follow-up. Compared with women, men had a 10% lower risk of discontinuation of drug treatment (95% confidence interval: 8–12). Persistence on antihypertensive treatment was better in men than in women, this being the case in both younger (40–64 years) and older patients (65–80 years), in patients starting treatment with any major antihypertensive drug and in patients who had a low comorbidity status. There was no evidence that men and women had a different risk of treatment discontinuation when their comorbidity status was worse, or initial antihypertensive treatment was based on drug combinations.

Conclusion: Our data show that in a real-life setting, men are more persistent to antihypertensive drug therapy than women.

aNational Centre for Healthcare Research and Pharmacoepidemiology

bDepartment of Statistics and Quantitative Methods, University of Milano-Bicocca

cEpidemiologic Observatory, Lombardy Regional Health Service

dUniversity of Milano-Bicocca, Milan

ePoliclinico di Monza, Monza, Italy

Correspondence to Federico Rea, Dipartimento di Statistica e Metodi Quantitativi, Sezione di Biostatistica, Epidemiologia e Sanità Pubblica, Università degli Studi di Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy. Tel: +39 02 64485859; e-mail:

Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; BP, blood pressure; CCBs, calcium channel blockers; CI, confidence interval; MCS, Multisource Comorbidity Score; NHS, National Health Service; PDC, proportion of days covered

Received 5 March, 2019

Revised 23 June, 2019

Accepted 29 July, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.