Patterns of prescription of antihypertensive medications in Poland: a one-year assessment of initiation and persistence of therapy in a nationwide population cohort.

Objective: This study assessed the prescribing patterns and treatment persistence of antihypertensive medications over a 12-month period in a nationwide cohort from Poland.

Methods: We examined data on all 141 668 patients in Poland who received their first hypertension prescription in January 2021, sourced from the e-Health Centre database encompassing all filled prescriptions. Treatment persistence over the first 12 months was assessed as a measure of long-term adherence. We assessed the degree of persistence to therapy as the percentage of patients having a supply of the drug for each consecutive month until the end of follow-up.

Results: Antihypertensive therapy was started with a monotherapy in 57% of cases; 23% (21% of women and 25% of men; P  < 0.001) started with a two-drug antihypertensive combination and 13% (11% of women, 17% of men; P  < 0.001) with a single-pill combinations (SPCs). Only 33% of patients (29% of women, 36% of men; P  < 0.001) received drug classes combinations endorsed by guidelines. Treatment persistence after 1 year exhibited significant age-related disparities - persisting in 17-53% among younger and middle-aged individuals, and 59-87% among older patients. Initiation with an SPC was associated with higher 1-year persistence. Among patients still on antihypertensive therapy at 12 months, 30% were on monotherapy, 27% on two drugs, and 43% on three or more agents.

Conclusion: In Poland, monotherapy is the predominant first line treatment of hypertension. A substantial proportion of younger and middle-aged patients discontinue therapy within the first year. The use of SPCs at initiation is associated with an improved long-term persistence.