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Drug treatment discontinuation and achievement of target blood pressure and cholesterol in United Kingdom primary care

ABSTRACT Aim: This cohort study evaluated medication discontinuation and target achievement in a United Kingdom primary care setting. Methods: The study population comprised patients within the General Practice Research Database who began treatment for hypertension, dyslipidaemia or both between 1997 and 2001. Discontinuation (absence of prescription refill ≥ 6 months) and reaching treatment targets (blood pressure < 140/90 mmHg, or < 130/80 mmHg in patients with diabetes; total cholesterol < 193 mg/dL [5 mmol/L] or low-density lipoprotein cholesterol < 116 mg/dL [3 mmol/L]) were determined for patients treated for hypertension alone (cohort HT), dyslipidaemia alone (cohort DYS) and both conditions (cohort HT+DYS). Results: At 2 years, 41.3% (95% CI: 40.8, 41.9%) of patients had stopped treatment in cohort HT, 29.2% (27.6, 30.9%) in cohort DYS and 25.0% (24.3, 25.8%) stopped either treatment in cohort HT+DYS. The cumulative proportion reaching treatment targets at this time was 28.2% (27.8, 28.7%) in cohort HT and 49.9% (47.8, 51.9%) in cohort DYS; in cohort HT+DYS, 43.4% (42.6, 44.2%) achieved blood pressure target, 53.7% (52.8, 54.6%) cholesterol target and 24.8% (24.0, 25.5%) reached target for both. Diabetic patients generally stayed on treatment longer and were less likely to attain their blood pressure targets, and more likely to reach cholesterol targets, compared with all patients. Conclusion: Patients prescribed both antihypertensive and lipid-lowering therapy remained on treatment longer; more patients achieved treatment target than those treated for single risk factors. Nevertheless, there is a large unmet need for initiating and maintaining antihypertensive and lipid-lowering therapy in patients with hypertension and dyslipidaemia.