Systematic review of observational data shows wide variation in primary care discontinuation of lipid-lowering and antihypertensive therapies

Background Cardiovascular disease (CVD) constitutes a major global burden of disease. CVD risk can be managed in primary care using lipid-lowering therapies (LLTs) and antihypertensives (AHTs), for either primary (no prior CVD) or secondary (with prior CVD) prevention, but patients may discontinue treatment. Previous studies have demonstrated that LLT and AHT discontinuation is common, but little synthesised real world data for LLT/AHT discontinuation exists. Methods We systematically reviewed English language reports of observational studies from PubMed, EMBASE, Web of Science, and CINAHL published from 2010-2025 describing discontinuation/restarting prevalence for first-to-third line LLTs/AHTs used for CVD prevention in primary care (PROSPERO: CRD420250599340). Summary data were extracted from included studies, including discontinuation/restarting prevalences and associations between discontinuation and sociodemographic factors. Findings Of 5,756 records we included 31 reports (16 LLT; 15 AHT) representing 9,146,252 patients overall, though databases were re-used between studies. Risk of bias was generally low except for two papers with substantial risk of bias due to unmeasured confounding. One-year discontinuation prevalences were 9%-84% (LLTs), and 10% 64% (AHTs). Restarting prevalences were 12%-75% (LLTs), and 18%-28% (AHTs). Discontinuation/restarting prevalence depended on discontinuation definition and indication. Patients aged ~65 years old were less likely to discontinue than younger or older patients. Women discontinued LLTs more often irrespective of indication; men discontinued AHTs more often for primary prevention. The association between SEP and LLT/AHT discontinuation was unclear; income-based SEP measures were associated with discontinuation, but composite measures were not. People from minority ethnic groups were more likely to discontinue LLTs and AHTs. Interpretation This systematic review of real-world data identified patterns of discontinuation of first to-third line LLTs and AHTs based on age, sex, and ethnicity. Awareness of these patterns and additional research into patient-level drivers of drug discontinuation could improve health equity by addressing LLT/AHT discontinuation in the highest risk patients. Funding This work was funded by the NIHR UCLH BRC. No funders had any role in data collection, analysis, manuscript preparation, or the decision to publish.