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To assess the proportion of patients starting with antihypertensive drug treatment who continued treatment for at least 10 years.A retrospective cohort study.The PHARMO record linkage system containing drug dispensing records from community pharmacies and linked hospital discharge records of approximately 950 000 subjects.Patients who started using antihypertensive drugs (two or more prescriptions) in 1992 and did not receive a prescription for any antihypertensive drug in the 365 days preceding the first prescription.Persistence with antihypertensive drugs until 10 years.Among a total of 2325 patients who started using antihypertensive drugs, 39% used continuously during the 10 years of follow-up. Approximately 22% temporarily discontinued and restarted treatment, whereas 39% of patients discontinued permanently. Older patients were more persistent than younger patients [20–39 years: odds ratio (OR) 2.08; 95% confidence interval (CI) 1.52–2.84; 40–59 years: (reference), ≥ 60 years: OR 0.69; 95% CI 0.54–0.89]. More patients who started with diuretics (reference) and beta blockers (OR 1.15; 95% CI 0.87–1.52) discontinued compared with those who started with dihydropyridine calcium antagonists (OR 0.54; 95% CI 0.34–0.84), and angiotensin-converting enzyme (ACE) inhibitors (OR 0.38; 95% CI 0.27–0.55). Patients who started with combination therapy (OR 0.29; 95% CI 0.14–0.54 compared with diuretics) or patients who were initially treated by a cardiologist (OR 0.82; 95% CI 0.61–0.97) or internist (OR 0.80; 95% CI 0.62–0.98 compared with general practitioners) also showed higher persistence.Long-term persistence in daily practice is low compared with persistence observed in randomized clinical trials and should be considered in the choice of a first-line antihypertensive agent.