ARB medications lead to better adherence to the treatment of hypertension.

ARB medications lead to better adherence to the treatment of hypertension.

Influence of drug selection on hypertension treatment

Patients who start their hypertension treatment with ARB (angiotensin receptor blocker) medications are more likely to continue the same medication than patients who start with other medications. The right choice of medication at the outset can therefore improve both health and quality of life and reduce healthcare costs. This is shown by a new study based on data from 340,000 patients.

If we can get more patients to stay on their hypertension medication and not stop their treatment, their cardiovascular health will clearly improve and they will live longer. At the same time, health care costs decrease when patients are prescribed the drug they are most likely to continue taking right from the start. For patients and physicians, this means that ARB medications should be the preferred choice when initiating treatment for hypertension unless there are obvious reasons to choose another medication.

Karl Laurell, researcher, Uppsala University

A risk factor for cardiovascular disease

High blood pressure is the most important risk factor for cardiovascular disease and premature death. It is estimated that at least 1.8 million people in Sweden have high blood pressure. There are several effective medications that can lower blood pressure and prolong life, but despite these options, many patients do not achieve their treatment goals. Many also stop taking their medication. The researchers of this study therefore wanted to investigate whether the choice of the first drug influences the long-term effectiveness of the treatment.

The study compared the four drug classes most recommended for the treatment of high blood pressure: angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEi), calcium channel blockers (CCBs), and thiazide/thiazide-like diuretics (TDs).

340,000 participants

The study is based on data from several national health registries and includes more than 340,000 people with high blood pressure but no previous cardiovascular disease. Participants began treatment between 2011 and 2018 and were followed over several years, focusing on how well they remained on their initial treatment.

Fewer side effects with ARB treatment

The results show that patients who started ARBs remained on the same medication class over time to a greater extent than others. After five years, 80 percent of these patients still had good adherence to their original medication, compared to just 65 percent for calcium channel blockers, the second best class of medication. The majority of those who stopped taking their medication continued their treatment with another high blood pressure medication, most often ARB.

"The root cause is probably that ARBs have fewer side effects than other medications. Patients who are already using another high blood pressure medication that works well for them and doesn't cause side effects have no reason to switch. However, it is important to check blood pressure regularly because it often increases with age and additional medications may need to be added," says Laurell.

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