Right blood pressure drug can reduce healthcare costs

Patients who start their blood pressure treatment with ARB drugs continue with the same medicine to a greater extent than patients who start out with other drugs. Choosing the right drug from the outset can therefore improve both health and quality of life – as well as bringing down healthcare costs. This is shown in a new study based on data from 340,000 patients.

“If we can get more patients to continue taking their blood pressure medication and refrain from discontinuing their treatment, this will clearly improve their cardiovascular health and they will live longer,” says Karl Laurell, a researcher at Uppsala University. “At the same time, healthcare costs decrease if patients are prescribed the medicine they are most likely to persist with from the start. For patients and doctors, these findings mean that ARB drugs should be the preferred choice when treatment for high blood pressure is initiated, unless there are obvious reasons to choose something else.”

A risk factor for cardiovascular disease

High blood pressure is the most important risk factor for cardiovascular disease and premature death. At least 1.8 million people in Sweden are estimated to have high blood pressure. There are several effective drugs that lower blood pressure and prolong life, but despite this, many patients fail to achieve their treatment goals. Many also stop taking their medicine. The researchers in this study therefore wanted to investigate whether the choice of the first medication affects the way the treatment works in the longer term.

The study compared the four classes of drugs that are recommended most strongly for treating high blood pressure: angiotensin receptor blocker (ARB), angiotensin-converting enzyme inhibitor (ACEi), calcium channel blocker (CCB), and thiazide/thiazide-like diuretic (TD).

340,000 participants

The study is based on data from several national healthcare registers and involves more than 340,000 people with high blood pressure but without previous cardiovascular disease. The participants began their treatment between 2011 and 2018 and were followed for several years, focusing on how well they persisted with their original treatment.

Fewer side effects with ARB treatment

The results show that patients who started with ARB continued with the same drug class over time to a greater extent than others. After five years, 80 per cent of these patients were still showing good adherence to their original medicine, compared with 65 per cent for calcium channel blockers, the second best drug class. The majority of those who stopped taking their medicine continued their treatment but with another blood pressure drug, usually ARB.

“The primary explanation is probably that ARB has fewer side-effects than other drugs. Patients who are already using another blood pressure medicine that works well for them without side-effects have no reason to change. Having said that, it’s important to check your blood pressure regularly as it often rises with age and further medication may then need to be added,” says Laurell.