Evidence map›Paper›PMID 9934342›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1999

Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data.

J J Caro, J L Speckman, M Salas, G Raggio, J D Jackson

Abstract read
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In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  6. Should thiazide diuretics be given as first line antihypertensive therapy or in addition to other medications?High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2015
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  14. Use of an olmesartan medoxomil-based treatment algorithm for hypertension control.Journal of clinical hypertension (Greenwich, Conn.) · 2004
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41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

J J CaroCaro Research, Concord, Mass., USA. jcaro@caroresearch.com
J L Speckman
M Salas
G Raggio
J D Jackson

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRational medical decisions should be based on the best possible evidence. Clinical trial results, however, may not reflect conditions in actual practice. In hypertension, for example, trials indicate equivalent antihypertensive efficacy and safety for many medications, yet blood pressure frequently remains uncontrolled, perhaps owing to poor compliance. This paper examines the effect of initial choice of treatment on persistence with therapy in actual practice.

methodsThe authors examined all outpatient prescriptions for antihypertensive medications filled in Saskatchewan between 1989 and 1994 by over 22,000 patients with newly diagnosed hypertension whose initial treatment was with a diuretic, beta-blocker, calcium-channel blocker or angiotensin-converting-enzyme (ACE) inhibitor. Rates of persistence over the first year of treatment were compared.

resultsAfter 6 months, persistence with therapy was poor and differed according to the class of initial therapeutic agent: 80% for diuretics, 85% for beta-blockers, 86% for calcium-channel blockers and 89% for ACE inhibitors (p < 0.001). These differences remained significant when age, sex and health status in the previous year were controlled for. Changes in the therapeutic regimen were also associated with lack of persistence.

interpretationA relation not seen in clinical trials--between persistence with treatment and initial antihypertensive medication prescribed--was found in actual practice. This relation also indicates the importance of real-world studies for evidence-based medicine.

Indexed as

Evidence-Based MedicineAdultAgedAntihypertensive AgentsCohort StudiesDecision MakingFemaleHumansHypertensionMaleMiddle AgedPatient CompliancePrimary Health CareAntihypertensive Agents

Identifiers

PMID9934342
PMCPMC1229944

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.