Gender Differences in Non‐Persistence with Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among Older Hypertensive Patients with Peripheral Arterial Disease

Abstract

The beneficial effects of angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in hypertensive patients with peripheral arterial disease (PAD) depends on long‐term persistence. The aims of our study were to analyse gender differences in nonpersistence with ACEIs/ARBs, and to identify the characteristics associated with the likelihood of non‐persistence. Our study cohort included 7080 hypertensive patients (4005 women and 3075 men) aged ≥65 years, treated with ACEIs/ARBs, in whom PAD was diagnosed between 1 January and 31 December, 2012. Non‐persistence was identified according to a treatment gap of 6 months without ACEI/ARB prescriptions. The characteristics associated with non‐persistence were identified using the Cox regression model. At the end of the 5‐year follow‐up, 23.2% of the whole study cohort, 22.3% of men, and 23.9% of women were non‐persistent with ACEIs/ARBs, with no significant gender differences in persistence. While a number of characteristics were associated with non‐persistence, only three characteristics had consistent, statistically significant associations in both genders: being a new ACEI/ARB user increased the likelihood of non‐persistence, and general practitioner as index prescriber and increasing the overall number of medications decreased the likelihood of non‐persistence. Information on the differences in characteristics that are associated with non‐persistence between genders may help to better identify patients for whom special attention should be paid to improve their persistence.