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Liang W, Zhang X, Wang Q, Yu H, Yu J. Assessing the evolution of hypertension management in Gansu, China: A comparative study of prevalence, awareness, treatment, and control in 2012 and 2022. J Clin Hypertens (Greenwich) 2024; 26:674-686. [PMID: 38577938 PMCID: PMC11180686 DOI: 10.1111/jch.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
The aim of this study is to evaluate the developments in the treatment and prevalence of hypertension by demographic subgroups in least developed area of China in 2012 and 2022. This population-based cross-sectional study was conducted in 2012 and 2022, we applied stratified multistage random sampling to investigate residents aged 18 years or older in Gansu, the least developed province in the northwest of China. Questionnaires and anthropometric measurements were given to all respondents. The standardized prevalence of hypertension in adults in Gansu increased from 26.1% in 2012 to 28.8% in 2022. Compared with 2012, the control rate remains decreased despite the significantly improved awareness and treatment rates of hypertension in 2022. Apart from the reversal of the control rate, the trend of higher prevalence in men and higher awareness and treatment rates in women has not changed. There was an obviously increase in the proportion of participants who had received health education and hypertension management services from medical workers. The treatment was still primarily monotherapy, and there was no significant improvement in the prescription of medication. The prevalence of hypertension has increased mildly in the least developed region of China over the past decade, and the challenge of hypertension management has shifted from increasing awareness and treatment rates to increasing control rates. The onset and control of hypertension are affected by education methods, BMI, local economic conditions and other factors, and targeted strategies can be adopted to strengthen the management of hypertension in economically underdeveloped areas of China.
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Affiliation(s)
- Wei Liang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Xiaowei Zhang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Qiongying Wang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Heng Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Jing Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
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Lin PD, Rifas‐Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024; 13:e032197. [PMID: 38639340 PMCID: PMC11179868 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - John Merriman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Joshua Petimar
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Han Yu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFLUSA
| | - William J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical InformaticsUniversity of FloridaGainesvilleFLUSA
| | - Jessica Young
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Jason P. Block
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
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Satoh M, Muroya T, Murakami T, Obara T, Asayama K, Ohkubo T, Imai Y, Metoki H. The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan. Hypertens Res 2024; 47:598-607. [PMID: 37872377 DOI: 10.1038/s41440-023-01452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 10/25/2023]
Abstract
We aimed to quantify the impact of inadequate pharmacological therapy on uncontrolled blood pressure (BP) using Japanese real-world data. This retrospective cohort study used databases provided by DeSC Healthcare, Inc (Tokyo, Japan). We identified 27,652 patients with hypertension (age, 60.7 ± 9.1 years; men, 56.4%) who were not receiving antihypertensive treatment at the initial visit (pre-treatment) and were under treatment at the next visit (post-treatment). Patients were classified into the following groups by the number of antihypertensive drug classes and defined daily dose (DDD): one antihypertensive drug class with a low dose (DDD < 1.0), one antihypertensive drug class with a moderate-to-high dose (DDD ≥ 1.0), two antihypertensive drug classes with a low dose (DDD < 2.0), two antihypertensive drug classes with a moderate-to-high dose (DDD ≥ 2.0), and ≥three antihypertensive drug classes. The pre-treatment systolic/diastolic BP was 157.7 ± 15.4/94.2 ± 11.5 mmHg. Overall, 43.0% of patients had uncontrolled BP (post-treatment BP ≥ 140/ ≥ 90 mmHg). High pre-treatment BP was a strong factor for uncontrolled BP. After adjustments for covariates, including the pre-treatment mean BP, the proportion of patients with uncontrolled BP was 2.08 times higher in the one antihypertensive drug class with a low dose group than in the ≥three antihypertensive drug classes group. The preventable fraction due to
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Affiliation(s)
- Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
| | - Tomoko Muroya
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Internal Medicine, Izumi Hospital, Sendai, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Taku Obara
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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Teles F, Peçanha de Miranda Coelho JA, Albino RM, Verçosa Pacheco FC, Rodrigues de Oliveira E, Silveira MAD, Diógenes M. Feitosa A, Bezerra R. Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2023; 45:2163903. [PMID: 36637019 PMCID: PMC9848247 DOI: 10.1080/0886022x.2022.2163903] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Thiazide diuretics are first-line drugs for the treatment of hypertension, but hypertension treatment guidelines have systematically discouraged their use in patients with advanced chronic kidney disease (CKD). For the first time, a systematic review and random-effects meta-analysis were performed to assess the effectiveness of thiazides and thiazide-like diuretics to treat hypertension in patients with stages 3b, 4, and 5 CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review and random-effects meta-analysis that included a literature search using the following databases were performed: MEDLINE through PubMed, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) through the Cochrane Library, Embase, and ISI - Web of Science (all databases). Prospective studies that evaluated the effectiveness of thiazide and thiazide-like diuretics in individuals with a GFR < 45 mL/min/1.73 m2 were included. RESULTS Five clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m2 to 26.8 ± 8.8 mL/min/1.73 m2. There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion. CONCLUSION Thiazide and thiazide-like diuretics seem to maintain their effectiveness in lowering blood pressure in patients with advanced chronic kidney disease. These findings should spur new prospective randomized trials and spark discussions, particularly about upcoming hypertension guidelines.
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Affiliation(s)
- Flávio Teles
- School of Medicine, Federal University of Alagoas (UFAL), Maceió, Brazil,School of Medicine, State University of Health Sciences of Alagoas (UNCISAL), Maceió, Brazil
| | | | - Rosivânia Maria Albino
- School of Medicine, State University of Health Sciences of Alagoas (UNCISAL), Maceió, Brazil
| | | | | | | | | | - Rodrigo Bezerra
- Pernambuco Hypertension Service (SHIP), PROCAPE - University of Pernambuco (UPE), Recife, Brazil,Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil,CONTACT Rodrigo Bezerra PROCAPE-University of Pernambuco, Brazil. Rua dos Palmares, S/N – Santo Amaro, Recife – PE - CEP: 74970-240, Brazil
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Nádasy GL, Balla A, Szekeres M. From Living in Saltwater to a Scarcity of Salt and Water, and Then an Overabundance of Salt-The Biological Roller Coaster to Which the Renin-Angiotensin System Has Had to Adapt: An Editorial. Biomedicines 2023; 11:3004. [PMID: 38002004 PMCID: PMC10669630 DOI: 10.3390/biomedicines11113004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Angiotensin II (Ang II) is a hormone with much more complex actions than is typical for other agonists with heterotrimeric G protein-coupled receptors (GPCRs) [...].
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Affiliation(s)
- György L. Nádasy
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
| | - András Balla
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
- Laboratory of Molecular Physiology, Eötvös Loránd Research Network, Research Centre for Natural Sciences, 2 Magyar Tudósok Körútja, 1117 Budapest, Hungary
| | - Mária Szekeres
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, 17 Vas Street, 1088 Budapest, Hungary
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Park CS, Kim B, Rhee TM, Lee HJ, Lee HS, Park JB, Kim YJ, Han KD, Kim HK. Association between renin-angiotensin-aldosterone system blockade and clinical outcomes in patients with hypertension: real-world observation from a nationwide hypertension cohort. Clin Res Cardiol 2023; 112:1577-1586. [PMID: 36867200 DOI: 10.1007/s00392-023-02179-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE We investigated the association between the use of ACEi, ARB, or non-renin-angiotensin-aldosterone system inhibitors (non-RASi) and incident cardiovascular events in an unselected nationwide hypertension cohort. METHODS The information regarding 2,025,849 patients who underwent general health checkup between 2010 and 2011 and were on antihypertensive medication was collected. Patients were allocated into ACEi, ARB, and non-RASi groups and followed until 2019. The outcomes of interest were myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause deaths. RESULTS Patients on ACEi and ARB showed unfavorable baseline characteristics compared to those on non-RASi. After adjusting for covariates, the ACEi group showed lower risks of MI, AF, and all-cause deaths (HR (95% CI): 0.94 (0.89-0.99), 0.96 (0.92-1.00), and 0.93 (0.90-0.96), respectively), but similar risks of IS and HF (0.97 (0.92-1.01) and 1.03 (1.00-1.06), respectively), compared to the non-RASi group. Likewise, the ARB group showed decreased risks of MI, IS, AF, HF, and all-cause deaths (HR (95% CI): 0.93 (0.91-0.95), 0.88 (0.86-0.90), 0.86 (0.85-0.88), 0.94 (0.93-0.96), and 0.84 (0.83-0.85)), compared to the non-RASi group. Sensitivity analysis of patients taking a single antihypertensive medication showed similar results. In the propensity score matching (PSM) cohort, the ARB group showed similar risks of MI and decreased risks of IS, AF, HF, and all-cause deaths compared to the ACEi group. CONCLUSIONS ACEi and ARB users were associated with decreased risks of MI, IS, AF, HF, and all-cause deaths, compared to non-RASi users.
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Affiliation(s)
- Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Sun Lee
- Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Jiao T, Platt RW, Douros A, Filion KB. Use of a Statistical Adaptive Treatment Strategy Approach for Emulating Randomized Controlled Trials Using Observational Data: The Example of Blood-Pressure Control Strategies for the Prevention of Cardiovascular Events Among Individuals With Hypertension at High Cardiovascular Risk. Am J Epidemiol 2023; 192:1576-1591. [PMID: 37073411 DOI: 10.1093/aje/kwad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 10/12/2022] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
Statistical approaches to adaptive treatment strategies (ATS) can be used to mimic the sequential decision-making inherently found in clinical practice. To illustrate the use of a statistical ATS approach, we emulated a target trial of different blood pressure (BP) control plans for the prevention of cardiovascular events among individuals with hypertension at high cardiovascular risk, inspired by the Systolic Blood Pressure Intervention Trial (SPRINT). We included 103,708 patients with hypertension and a "QRISK3" estimated 10-year risk of cardiovascular disease of ≥20% who initiated an antihypertensive drug between 1998 and 2018. Dynamic marginal structural models estimated the comparative effects of treating patients with intensive (target BP: 130/80 mm Hg), standard (140/90 mm Hg), and conservative (150/90 mm Hg) BP control strategies. The adjusted hazard ratios (HRs) for the intensive versus standard strategy were 0.96 (95% confidence interval (CI): 0.92, 1.00) for major adverse cardiovascular events and 0.93 (95% CI: 0.88, 0.97) for death from cardiovascular causes. For the conservative versus standard strategy, they were 1.06 (95% CI: 1.02, 1.10) and 1.08 (95% CI: 1.03, 1.13), respectively. These results are largely compatible with SPRINT. ATS can be used to emulate randomized controlled trials of complex treatment strategies in an observational setting and represents an alternative approach for situations where randomized controlled trials are not feasible.
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Li X, Bijlsma MJ, Bos JHJ, Schuiling-Veninga CCM, Hak E. Long-term comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events: a population-based retrospective inception cohort study in the Netherlands. BMJ Open 2023; 13:e068721. [PMID: 37558444 PMCID: PMC10414115 DOI: 10.1136/bmjopen-2022-068721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the long-term effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events. DESIGN Retrospective inception cohort study covering a 25-year study period. SETTING University Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020. PARTICIPANTS Patients aged 18 years or older, free of any cardiovascular disease (CVD) drug therapies prior to initiation of a preventive antihypertensive monotherapy (ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and thiazides). OUTCOME MEASURES Primary outcome was the time to first prescription of acute cardiac drug therapy (CDT) measured by valid drug proxies to identify a first major CVD event in patients without a history of CVD. RESULTS Among 33 427 initiators, 5205 (15.6%) patients experienced an acute CDT. The average follow-up time was 7.9±5.5 years. The 25-year incidence rate per 1000 person-years were 25.3, 22.4, 18.2, 24.4 and 22.0 for ACEI, ARB, BB, CCB and thiazide starters, respectively. Inverse probability of treatment-weighted Cox regression showed that thiazide starters had lower hazards than the reference BB starters (HR: 0.88, 95% CI: 0.81 to 0.95). Among patients on diabetes drugs, risks were lower (HR: 0.49, 95% CI: 0.28 to 0.85). CCB starters had higher hazards than reference BB (HR: 1.21, 95% CI: 1.07 to 1.36). The overall estimated number needed to treat for thiazides compared with BBs to prevent one acute CDT in 25 years was 26, and four among patients on diabetes drugs. CONCLUSIONS After adjustments for confounders, patients starting on monotherapy with thiazides had a lower incidence of CDT compared with those starting on BBs, notably among patients on diabetes drugs. Conversely, patients who began CCB monotherapy had a higher incidence of CDT compared with those starting on BBs. Other monotherapies had comparable incidence of cardiovascular disease compared with BBs.
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Affiliation(s)
- Xuechun Li
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Maarten J Bijlsma
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Jens H J Bos
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Rashikh MA, Alruways AF, Alotaibi HB, Alotaibi NA, Almarshad F, Alsaab SM, Alotaibi G. Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study. Cureus 2023; 15:e34965. [PMID: 36938155 PMCID: PMC10019097 DOI: 10.7759/cureus.34965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Background Hypertension is the leading risk factor for cardiovascular disease and death. Appropriate treatment of hypertension is necessary to reduce mortality. A prescription-based study is one of the most influential and helpful methods to examine physicians' irrational prescribing practices. This study was designed to investigate the antihypertensive prescription of physicians and their adherence to the treatment guidelines, as well as the blood pressure (BP) control rate in a general hospital in the Kingdom of Saudi Arabia. Methodology A retrospective, cross-sectional study was conducted between February 2020 and June 2021 in an outpatient department. Patients diagnosed with hypertension as per the 2020 International Society of Hypertension guidelines and those who received antihypertensive drugs were included. Study data included prescriptions, patient's age, duration of hypertension, comorbidities, BP, drug therapy type, and antihypertensive class. Results Overall, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (67.1%) were the most prescribed agents, followed by dihydropyridine-calcium channel blockers (62.6%), diuretics (26.1%), and β-blockers (10.1%). Comorbid and stage 2 hypertensive patients mainly received combination therapy (51.6%) rather than monotherapy (48.4%). The study revealed an 83.5% prescription adherence to the treatment guidelines. However, non-adherence was encountered in monotherapy, polytherapy, and elderly-treated patient groups. A 66.4% (at target BP in all cases <140/90 mmHg) and 39.3% (at target BP in comorbid patients <130/80 mmHg) rate of BP control was observed. Furthermore, the rate of BP control was significantly associated with prescription adherence (χ2 = 71.316; p < 0.001). Conclusions The degree of prescription adherence and rate of BP control were found to be compatible with other published hypertension studies. However, considerable scope exists for improvement in rational drug utilization and rate of BP control, particularly in high-risk patients. Therefore, treatment guidelines must be followed by clinicians to achieve BP goals and reduce cardiovascular events among the Saudi population.
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Affiliation(s)
- Mohammad A Rashikh
- Department of Pharmacology, College of Medicine, Shaqra University, Dawadmi, SAU
| | | | | | - Nemer A Alotaibi
- Department of Pediatrics, Dawadmi College of Medicine, Shaqra University, Riyadh, SAU
| | - Feras Almarshad
- Department of Internal Medicine, College of Medicine, Shaqra University, Shaqra, SAU
| | - Saad M Alsaab
- Department of Internal Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | - Ghallab Alotaibi
- Department of Pharmacology, College of Pharmacy, Shaqra University, Dawadmi, SAU
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The Utilization, Expenditure, and Price of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the US Medicaid Programs: Trends Over a 31 Year Period. Int J Cardiol 2023; 370:412-418. [PMID: 36306953 DOI: 10.1016/j.ijcard.2022.10.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used for several indications including hypertension. Our aim is to evaluate the utilization, expenditure, and drug price of ACEIs and ARBs in the US Medicaid population. METHODS A retrospective descriptive trend analysis was conducted using Medicaid State Drug Utilization outpatient pharmacy summary files managed by the Centers for Medicare and Medicaid Services from 1991 to 2021. Study drugs included ACEIs (e.g., captopril) and ARBs (e.g., losartan). Annual reimbursement and utilization were calculated for both classes. The average reimbursement per prescription was calculated as a proxy for drug prices. Market share competition between ACEIs and ARBs was analyzed over time. RESULTS ACEI and ARB utilization rose by 25% from 1991 to 2021. Brand ACEIs utilization peaked in 2002 with 28 million prescriptions while brand ARBs utilization continued to increase until 2005 with over 23 million prescriptions. However, generic products took the lead and exceeded brand ACEI and ARB utilization in 2006 and 2012 respectively. Medicaid spent over $ 33.7 billion on ACEIs and ARBs over 31-year. Brand ACEIs and ARBs average prices increased sharply to $8,104 and $6,908 respectively in 2021. The total prescription market share for ACEIs was 68% compared to 32% of ARBs over the entire study. CONCLUSION ACEIs and ARBs utilization increased over the last 31 years. Brand utilization switched over to generic resulting in less reimbursement. The average prices of brand ACEIs and ARBs continue to increase even after generics were introduced to the market.
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Hassanein M, Akbar MAJ, Al-Shamiri M, Amir A, Amod A, Chudleigh R, Elhadd T, Heshmat H, Jibani M, Al Saleh YM. Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies. Diabetes Ther 2022; 13:1253-1280. [PMID: 35679010 PMCID: PMC9178531 DOI: 10.1007/s13300-022-01282-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings relevant to the safety and efficacy for therapies relating to these conditions. Of relevance to the Gulf region, the risk of hypoglycaemia with sulfonylureas during Ramadan was reviewed. For the management of T2D, sulfonylureas have been a long-standing medication used to achieve glycaemic control; however, differences have emerged between early and later generations, with recent studies suggesting improvements in the safety profiles of late-generation sulfonylureas. For patients with hypertension, incremental therapy changes are recommended to reduce the risk of cardiovascular complications that are associated with increasing blood pressure. For first-line therapy, angiotensin-converting enzyme inhibitors (ACEi), such as perindopril, have been demonstrated to reduce the risk of cardiovascular and all-cause mortality. The addition of calcium channel blockers and diuretics to ACEi has been shown to be effective in patients with poorly controlled hypertension. The different renin-angiotensin-aldosterone system inhibitors are reviewed, and the benefit of combination therapies, including amlodipine and indapamide in patients with difficult-to-control hypertension, is investigated. The benefits of lifestyle modifications for these patients are also discussed, with important clinical considerations that are expected to inform patient management in daily clinical practice.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital/Dubai Health Authority, Alkhaleej Road, PO Box 7272, Dubai, United Arab Emirates.
- Gulf Medical University, Ajman, United Arab Emirates.
| | | | - Mostafa Al-Shamiri
- Cardiac Sciences Department, Medical College, King Saud University, Riyadh, Saudi Arabia
| | - Ashraf Amir
- International Medical Center Hospital (IMC), Jeddah, Saudi Arabia
| | - Aslam Amod
- Nelson R. Mandela School of Medicine & Life Chatsmed Garden Hospital, Durban, South Africa
| | | | | | - Hussien Heshmat
- Cardiology Department, Cairo University, Cairo, Egypt
- Fujairah Hospital Emirates Health Service, Fujairah, United Arab Emirates
| | | | - Yousef M Al Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Gurad Health Affairs, Riyadh, 14611, Saudi Arabia
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Rouette J, McDonald EG, Schuster T, Brophy JM, Azoulay L. Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study. BMJ Open 2022; 12:e057510. [PMID: 35688595 PMCID: PMC9189823 DOI: 10.1136/bmjopen-2021-057510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the prescribing trends of antihypertensive drugs in primary care patients and assess the trajectory of antihypertensive drug prescriptions, from first-line to third-line, in patients with hypertension according to changes to the United Kingdom (UK) hypertension management guidelines. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS We used the UK Clinical Practice Research Datalink, an electronic primary care database representative of the UK population. Between 1988 and 2018, we identified all adult patients with at least one prescription for a thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, beta-blocker or calcium channel blocker (CCB). PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the period prevalence of patients with antihypertensive drug prescriptions for each calendar year over a 31-year period. Treatment trajectory was assessed by identifying patients with hypertension newly initiating an antihypertensive drug, and treatment changes were defined by a switch or add-on of a new class. This cohort was stratified before and after 2007, the year following important changes to UK hypertension management guidelines. RESULTS The cohort included 2 709 241 patients. The prevalence of primary care patients with antihypertensive drug prescriptions increased from 7.8% (1988) to 21.9% (2018) and was observed for all major classes except thiazide diuretics. Patients with hypertension initiated thiazide diuretics (36.8%) and beta-blockers (23.6%) as first-line drugs before 2007, and ACE inhibitors (39.9%) and CCBs (31.8%) after 2007. After 2007, 17.3% were not prescribed guideline-recommended first-line agents. Overall, patients were prescribed a median of 2 classes (IQR 1-2) after first-line treatment. CONCLUSION Nearly one-quarter of primary care patients were prescribed antihypertensive drugs by the end of the study period. Most patients with hypertension initiated guideline-recommended first-line agents. Not all patients, particularly females, were prescribed recommended agents however, potentially leading to suboptimal cardiovascular outcomes. Future research should aim to better understand the implication of this finding.
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Affiliation(s)
- Julie Rouette
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Tibor Schuster
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - James M Brophy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Departmenf of Medicine, McGill University, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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13
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Schiffrin EL. From the Editor-in-Chief: Issue at a Glance. Am J Hypertens 2022; 35:1-2. [PMID: 34986217 DOI: 10.1093/ajh/hpab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ernesto L Schiffrin
- Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Rd., Montreal, Quebec, H3T 1E2, Canada
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