1
|
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.
Collapse
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
| |
Collapse
|
2
|
Lin Z, Cheung BMY, Tang V, Tsoi MF. Incidence of severe hypokalaemia in patients taking indapamide. Intern Emerg Med 2023; 18:549-557. [PMID: 36715848 DOI: 10.1007/s11739-023-03209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diuretics are commonly used for the treatment of hypertension. Yet, hypokalaemia is a well-recognised adverse effect. We conducted a retrospective study to evaluate the incidence of severe hypokalaemia, defined as requiring hospitalisation, among patients on indapamide. METHODS We searched a territory-wide database, Clinical Data Analysis and Reporting System of the Hong Kong Hospital Authority. We traced all hypertensive patients who had been prescribed indapamide in 2007-2016 and all admissions due to hypokalaemia in 2007-2018. Factors associated with hospitalisation were studied using multivariable logistic regression. RESULTS During the period studied, 62,881 patients were started on indapamide and 509 (0.8%) were hospitalised for hypokalaemia. 53% of these hospitalisations occurred within the first year of treatment, and half of those in the first year occurred during the first 16 weeks. Female sex (adjusted OR, 1.75; 95%CI, 1.45-2.12) and immediate-release formulation (adjusted OR, 1.41; 95%CI, 1.14-1.75) were associated with hospitalisation. In the multivariable model, advanced age was not a significant predictor. There were no deaths during hospitalisation and the median length of hospital stay was one day. CONCLUSIONS In this large population-based study with 147,319 person-years of follow-up, severe hypokalaemia requiring hospitalisation was uncommon among hypertensive patients on indapamide. The risk is higher in women and in the initial weeks and months after starting therapy. The use of the sustained-release formulation reduces the risk. We conclude that using indapamide to treat hypertension is safe, even in the elderly, especially if the sustained-release formulation is used and electrolytes are monitored periodically.
Collapse
Affiliation(s)
- Ziying Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Vicka Tang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Man Fung Tsoi
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
Collapse
Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
4
|
Kučan M, Lulić I, Pelčić JM, Mozetič V, Vitezić D. Cost effectiveness of antihypertensive drugs and treatment guidelines. Eur J Clin Pharmacol 2021; 77:1665-1672. [PMID: 34075437 DOI: 10.1007/s00228-021-03163-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/17/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI). METHODS The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€). RESULTS Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148. CONCLUSIONS Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.
Collapse
Affiliation(s)
- Marta Kučan
- Primorje-Gorski Kotar County Community Health Centre, Rijeka, Croatia.
| | - Igor Lulić
- Faculty of Engineering, University of Rijeka, Rijeka, Croatia
| | | | - Vladimir Mozetič
- Primorje-Gorski Kotar County Community Health Centre, Rijeka, Croatia
| | - Dinko Vitezić
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,University Hospital Centre Rijeka, Rijeka, Croatia
| |
Collapse
|
5
|
Sinnott S, Smeeth L, Williamson E, Perel P, Nitsch D, Tomlinson LA, Douglas IJ. The comparative effectiveness of fourth-line drugs in resistant hypertension: An application in electronic health record data. Pharmacoepidemiol Drug Saf 2019; 28:1267-1277. [PMID: 31313390 PMCID: PMC6771826 DOI: 10.1002/pds.4808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/04/2019] [Accepted: 05/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the utility of electronic health records from a routine care setting in assessing comparative effectiveness of fourth-line anti-hypertensive drugs to treat resistant hypertension. METHODS We conducted a cohort study using the Clinical Practice Research Datalink: a repository of electronic health records from UK primary care. We identified patients newly prescribed fourth-line anti-hypertensive drugs (aldosterone antagonist , beta-blocker, or alpha-blocker). Using propensity score-adjusted Cox proportional hazards models, we compared the incidence of the primary outcome (composite of all-cause mortality, stroke, and myocardial infarction) between patients on different fourth-line drugs. AA was the reference drug in all comparisons. Secondary outcomes were individual components of the primary outcome, blood pressure changes, and heart failure. We used a negative control outcome, Herpes Zoster, to detect unmeasured confounding. RESULTS Overall, 8639 patients were included. In propensity score-adjusted analyses, the hazard ratio for the primary outcome was 0.81 (95% CI, 0.55-1.19) for beta-blockers and 0.68 (95% CI, 0.46-0.96) for alpha-blockers versus AA. Findings for individual cardiovascular outcomes trended in a more plausible direction, albeit imprecise. A trend for a protective effect for Herpes Zoster across both comparisons was seen. CONCLUSIONS A higher rate of all-cause death in the AA group was likely due to unmeasured confounding in our analysis of the composite primary outcome, supported by our negative outcome analysis. Results for cardiovascular outcomes were plausible, but imprecise due to small cohort sizes and a low number of observed outcomes.
Collapse
Affiliation(s)
- Sarah‐Jo Sinnott
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Liam Smeeth
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Elizabeth Williamson
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Pablo Perel
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Dorothea Nitsch
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Laurie A. Tomlinson
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ian J. Douglas
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
6
|
Park C, Wang G, Ng BP, Fang J, Durthaler JM, Ayala C. The uses and expenses of antihypertensive medications among hypertensive adults. Res Social Adm Pharm 2019; 16:183-189. [PMID: 31085142 DOI: 10.1016/j.sapharm.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The literature lacks information about the use and cost of prescribed antihypertensive medications, especially by the type and class of medication prescribed. OBJECTIVE This study investigated the uses and expenses of antihypertensive medications among hypertensive adults in the United States. METHODS Using the 2014-2015 Medical Expenditure Panel Survey data, adult men and nonpregnant women aged 18 or older who had a diagnosis code of hypertension and used any prescribed antihypertensive medication were included in the study (n = 10,971). Adults with hypertension who were using a single antihypertensive medication were defined as single medication users, and those using two or more medications were defined as multiple medication users. Medications were classified into angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics (TDs), β-blockers (BBs), and others. The average annual total antihypertensive medication expenses and the expenditures of each medication class were estimated by using generalized linear models with a log link and gamma distribution and were adjusted to 2015 US dollars. RESULTS Among 10,971 hypertensive adults, 4759 (44.1%) were single medication users, and 6212 (55.9%) were multiple medication users. The average annual total cost for antihypertensive medications was $336 per person (95% confidence interval [CI] = $319-$353); $199 (95% CI = $177-$221) for single medication users and $436 (95% CI = $413-$459) for multiple medication users. The average annual costs for each medication class were estimated at $438 (95% CI = $384-$492) for ARBs and $49 for TDs (95% CI = $44-$55). CONCLUSIONS Users of multiple medications incurred more than twice the expense than single medication users. When comparing classes of medications, the cost for ARBs was the highest, whereas the cost for TDs was the lowest. This information can be used in evaluating the cost-effectiveness of antihypertension therapies.
Collapse
Affiliation(s)
- Chanhyun Park
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Boon Peng Ng
- College of Nursing & Disability, Aging and Technology Cluster, University of Central Florida, 12201 Research Parkway, Orlando, FL, 32826, USA
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Jeffrey M Durthaler
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, Atlanta, GA, 30341, USA
| |
Collapse
|
7
|
The History of Hypertension Guidelines in Canada. Can J Cardiol 2019; 35:582-589. [DOI: 10.1016/j.cjca.2019.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/23/2022] Open
|
8
|
Shin D, Lee ES, Kim J, Guerra L, Naik D, Prida X. Association Between the Use of Thiazide Diuretics and the Risk of Skin Cancers: A Meta-Analysis of Observational Studies. J Clin Med Res 2019; 11:247-255. [PMID: 30937114 PMCID: PMC6436572 DOI: 10.14740/jocmr3744] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022] Open
Abstract
Background Thiazide diuretics are among the most widely prescribed antihypertensive agents. Given their photosensitizing effects, however, there are concerns that they may increase the risk of skin cancers. In this meta-analysis, we investigated an association between the use of thiazide diuretics and the risk of skin cancers. Methods We identified studies by searching three electronic databases (PubMed, EMBASE, and the Cochrane Library) from their inception to October 30, 2017. Nine relevant observational studies (seven case-control and two cohort studies) were included in this study. Since included studies were unlikely to be functionally equal, pooled estimates were calculated using random-effects meta-analysis. Results The use of thiazide diuretics was associated with an increased risk of squamous cell carcinoma (adjusted odds ratio (aOR), 1.86; 95% confidence interval (CI), 1.23 - 2.80) and marginally increased risk of basal cell carcinoma (aOR, 1.19; 95% CI, 1.02 - 1.38) and malignant melanoma (aOR, 1.14; 95% CI, 1.01 - 1.29). In the subgroup analysis, hydrochlorothiazide or hydrochlorothiazide combination medications were significantly associated with squamous cell carcinoma without significant heterogeneity among studies (aOR, 2.04; 95% CI, 1.79 - 2.33; Higgin’s I2 value = 0.0 %; Q-statistics = 2.7, P value = 0.445). Conclusions Our results suggested that the use of thiazide diuretics may be associated with an increased risk of skin cancers. This association was most prominent between the use of hydrochlorothiazide or hydrochlorothiazide combination medications and the risk of squamous cell carcinoma. Further studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Doosup Shin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Eun Sun Lee
- Department of Internal Medicine, Louise A Weiss Memorial Hospital, Chicago, IL, USA
| | - Joonseok Kim
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Dayan Naik
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,New York Medical College, Valhalla, NY, USA.,Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Xavier Prida
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
9
|
Fuchs C, Wauschkuhn S, Scheer C, Vollmer M, Meissner K, Kuhn SO, Hahnenkamp K, Morelli A, Gründling M, Rehberg S. Continuing chronic beta-blockade in the acute phase of severe sepsis and septic shock is associated with decreased mortality rates up to 90 days. Br J Anaesth 2019; 119:616-625. [PMID: 29121280 DOI: 10.1093/bja/aex231] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 12/24/2022] Open
Abstract
Background There is growing evidence that beta-blockade may reduce mortality in selected patients with sepsis. However, it is unclear if a pre-existing, chronic oral beta-blocker therapy should be continued or discontinued during the acute phase of severe sepsis and septic shock. Methods The present secondary analysis of a prospective observational single centre trial compared patient and treatment characteristics, length of stay and mortality rates between adult patients with severe sepsis or septic shock, in whom chronic beta-blocker therapy was continued or discontinued, respectively. The acute phase was defined as the period ranging from two days before to three days after disease onset. Multivariable Cox regression analysis was performed to compare survival outcomes in patients with pre-existing chronic beta-blockade. Results A total of 296 patients with severe sepsis or septic shock and pre-existing, chronic oral beta-blocker therapy were included. Chronic beta-blocker medication was discontinued during the acute phase of sepsis in 129 patients and continued in 167 patients. Continuation of beta-blocker therapy was significantly associated with decreased hospital (P=0.03), 28-day (P=0.04) and 90-day mortality rates (40.7% vs 52.7%; P=0.046) in contrast to beta-blocker cessation. The differences in survival functions were validated by a Log-rank test (P=0.01). Multivariable analysis identified the continuation of chronic beta-blocker therapy as an independent predictor of improved survival rates (HR = 0.67, 95%-CI (0.48, 0.95), P=0.03). Conclusions Continuing pre-existing chronic beta-blockade might be associated with decreased mortality rates up to 90 days in septic patients.
Collapse
Affiliation(s)
- C Fuchs
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - S Wauschkuhn
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - C Scheer
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - M Vollmer
- Institute of Bioinformatics, University Hospital of Greifswald, Greifswald, Germany
| | - K Meissner
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - S-O Kuhn
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - K Hahnenkamp
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - A Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, La Sapienza, Rome, Italy
| | - M Gründling
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - S Rehberg
- Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| |
Collapse
|
10
|
Kucan M, Mrsic-Pelcic J, Vitezic D. Antihypertensive Drugs in Croatia: What Changes the Drug Usage Patterns? Clin Ther 2018; 40:1159-1169. [PMID: 30017168 DOI: 10.1016/j.clinthera.2018.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/10/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Possible factors that could influence changes in patterns of prescribing antihypertensives could be identified by monitoring national trends in hypertension treatment. The choice of pharmacologic treatment in people with hypertension has important therapeutic and financial implications, due to the fact that the financial costs associated with hypertension continue to increase. The aims of our study were to identify and analyze changes in the usage of antihypertensive drugs in Croatia from 2000 to 2016 and to identify the changes in prescribing patterns as well as mean prices per defined daily dose (DDD). METHODS Data on consumption in Croatia were obtained from the International Medical Statistics database. According to the World Health Organization's Collaborating Center for Drugs Statistics Methodology, per-annum volumes of drugs are presented in DDD per 1000 population per day (DDD/1000), while data on financial expenditure are presented in euros. FINDINGS The consumption of drugs for cardiovascular disease in Croatia during the period from 2000 to 2016 increased 150.81%, while financial expenditure in the same period increased 47.32%. The most frequently prescribed subgroup was agents acting on the renin-angiotensin system (RAS). Their share among antihypertensives increased from 39.13% (2000) to 53.39% (2016). The share of diuretics in the same period decreased from 20.16% in 2000 to 12.73% in 2016. IMPLICATIONS The prescribing patterns of antihypertensive drugs in Croatia have changed, which could be a result of a combination of different factors, such as changes in laws, pharmaceutical marketing, and guidelines on hypertension therapy. The most prescribed subgroup in all of the investigated years was agents acting on the RAS, mainly because of the increased prescribing of combinations of RAS agents plus diuretics. The financial implications of legal changes and the introduction of new generic drugs led to decreased cost per DDD of antihypertensives during the investigated period, but the total expenditure on antihypertensives in Croatia increased due to increased consumption.
Collapse
Affiliation(s)
- Marta Kucan
- University Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Dinko Vitezic
- University Hospital Center Rijeka, Rijeka, Croatia; University of Rijeka Medical School, Rijeka, Croatia
| |
Collapse
|
11
|
Use of Antihypertensive Drugs and Risk of Malignant Melanoma: A Meta-analysis of Observational Studies. Drug Saf 2017; 41:161-169. [DOI: 10.1007/s40264-017-0599-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
12
|
Ta JT, Erickson SC, Qiu WA, Patel BV. Is There a Relationship Between Part D Medication Adherence and Part C Intermediate Outcomes Star Ratings Measures? J Manag Care Spec Pharm 2017; 22:787-95. [PMID: 27348279 PMCID: PMC10397682 DOI: 10.18553/jmcp.2016.22.7.787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improvements in the Centers for Medicare & Medicaid Services (CMS) star ratings Part D medication adherence measures may affect performance in Part C intermediate outcome measures for which the Part D targeted medication classes are prescribed. OBJECTIVE To determine if Part D medication adherence measures are associated with corresponding Part C intermediate outcome measures. METHODS This was a cross-sectional analysis using the CMS 2015 star ratings report (based on 2013 benefit year plan data) for Medicare contracts. The measures of interest included the Part D adherence measures for diabetes medications, antihypertensive agents, and statins and the Part C intermediate outcome measures for controlled blood sugar, blood pressure, and cholesterol. All Medicare Advantage Prescription Drug (MAPD) contracts with complete data for all Part C and D measures of interest were included. Contracts with ≥ 25% of total enrollment with MA-only benefit were excluded. Linear and logistic regression models were used to assess the association between 2015 Part D adherence measures and Part C intermediate outcome measures (n = 366). The regression models were adjusted for low-income subsidy (LIS) beneficiary enrollment and log-transformed (natural logarithm) total contract enrollment. RESULTS Bivariate linear regression models demonstrated moderate positive associations between each of the 2015 Part D adherence scores and related 2015 Part C measures that explained 27%-29% (R(2)) of variance. Including LIS and total contract enrollment in the regression models increased the R2 to 30%-36%. The multivariate logistic regression models showed that each percentage point of improvement in the 2015 Part D adherence measures was associated with a 4.13 to 4.69 greater odds of performing in the top quartile in corresponding 2015 Part C measures. CONCLUSIONS Moderate positive associations were observed between the Part D and Part C scores in the same benefit year. MAPD plans may observe improved Part C intermediate outcome measures with strategies that improve Part D medication adherence measures. DISCLOSURES This study was conducted by MedImpact Healthcare Systems, San Diego, California, without external funding. All authors are employees of MedImpact Healthcare Systems. Erickson reports advisory board fees from Sanofi and AstraZeneca. Ta, Erickson, and Patel were responsible for study concept and design and data interpretation, with assistance from Qiu. Qiu and Ta took the lead in data collection, assisted by Erickson. Ta wrote the manuscript, which was revised by Erickson and Patel.
Collapse
Affiliation(s)
- Jamie T Ta
- 1 University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, and Specialty Pharmacy Research Assistant, MedImpact Healthcare Systems, San Diego, California
| | | | | | - Bimal V Patel
- 2 MedImpact Healthcare Systems, San Diego, California
| |
Collapse
|
13
|
Jackson EA, Ruppert K, Derby CA, Lian Y, Neal-Perry G, Habel LA, Tepper PG, Harlow SD, Solomon DH. Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN). J Am Heart Assoc 2017; 6:JAHA.116.004758. [PMID: 28232324 PMCID: PMC5524010 DOI: 10.1161/jaha.116.004758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Antihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women. Methods and Results Participants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42–52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow‐up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95% CI, 2.24–3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95% CI, 1.93–2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95% CI, 1.55–2.45) compared with whites. Use of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β‐blocker usage did not decrease over time. Conclusions Among this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.
Collapse
Affiliation(s)
- Elizabeth A Jackson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Kristine Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Yinjuan Lian
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Genevieve Neal-Perry
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Ping G Tepper
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Daniel H Solomon
- Division of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Chang TI, Evans G, Cheung AK, Cushman WC, Diamond MJ, Dwyer JP, Huan Y, Kitzman D, Kostis JB, Oparil S, Rastogi A, Roumie CL, Sahay R, Stafford RS, Taylor AA, Wright JT, Chertow GM. Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial. Hypertension 2016; 67:550-5. [PMID: 26865200 PMCID: PMC4755350 DOI: 10.1161/hypertensionaha.115.06851] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/22/2015] [Indexed: 02/03/2023]
Abstract
Thiazides and thiazide-type diuretics are recommended as first-line agents for the treatment of hypertension, but contemporary information on their use in clinical practice is lacking. We examined patterns and correlates of thiazide prescription in a cross-sectional analysis of baseline data from participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We examined baseline prescription of thiazides in 7582 participants receiving at least 1 antihypertensive medication by subgroup, and used log-binomial regression to calculate adjusted prevalence ratios for thiazide prescription (versus no thiazide). Forty-three percent of all participants were prescribed a thiazide at baseline, but among participants prescribed a single agent, the proportion was only 16%. The prevalence of thiazide prescription differed significantly by demographic factors, with younger participants, women, and blacks all having higher adjusted prevalence of thiazide prescription than other corresponding subgroups. Participants in the lowest category of kidney function (estimated glomerular filtration rate <30 mL/min per 1.73 m2) were half as likely to be prescribed a thiazide as participants with preserved kidney function. In conclusion, among persons with hypertension and heightened cardiovascular risk, we found that thiazide prescription varied significantly by demographics and kidney disease status, despite limited evidence about relative differences in effectiveness.
Collapse
Affiliation(s)
- Tara I Chang
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.).
| | - Gregory Evans
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Alfred K Cheung
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - William C Cushman
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Matthew J Diamond
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Jamie P Dwyer
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Yonghong Huan
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Dalane Kitzman
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - John B Kostis
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Suzanne Oparil
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Anjay Rastogi
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Christianne L Roumie
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Rukmani Sahay
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Randall S Stafford
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Addison A Taylor
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Jackson T Wright
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Glenn M Chertow
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| |
Collapse
|
15
|
Bjarnadóttir MV, Malik S, Onukwugha E, Gooden T, Plaisant C. Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data. PHARMACOECONOMICS 2016; 34:169-79. [PMID: 26660349 DOI: 10.1007/s40273-015-0333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design. METHOD We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode. RESULTS A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5 months. The average prescription cost of the period of continuous coverage ranged from US$3.44 (when the maximum gap was 0 day) to US$9.08 (when the maximum gap was 30 days). Results were less impactful when considering overlaps. CONCLUSIONS This proof-of-concept study illustrates the use of visual analytics tools in characterizing longitudinal medication possession. We find that prescription patterns and associated prescription costs are more influenced by allowable gap lengths than by definitions and treatment of overlap. Research using medication gaps and overlaps to define medication possession in prescription claims data should pay particular attention to the definition and use of gap lengths.
Collapse
Affiliation(s)
- Margrét V Bjarnadóttir
- Robert H. Smith School of Business, 4324 Van Munching Hall, College Park, MD, 20742, USA.
| | - Sana Malik
- Human-Computer Interaction Lab, University of Maryland, College Park, MD, USA
| | | | - Tanisha Gooden
- Pharmaceutical Research Computing, Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA
| | - Catherine Plaisant
- Human-Computer Interaction Lab, University of Maryland, College Park, MD, USA
| |
Collapse
|
16
|
Moura CS, Daskalopoulou SS, Levesque LE, Bernatsky S, Abrahamowicz M, Tsadok MA, Rajabi S, Pilote L. Comparison of the Effect of Thiazide Diuretics and Other Antihypertensive Drugs on Central Blood Pressure: Cross-Sectional Analysis Among Nondiabetic Patients. J Clin Hypertens (Greenwich) 2015; 17:848-54. [DOI: 10.1111/jch.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Cristiano S. Moura
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - Stella S. Daskalopoulou
- Division of Experimental Medicine; McGill University; Montreal QC Canada
- Division of General Internal Medicine; McGill University; Montreal QC Canada
| | - Linda E. Levesque
- Department of Public Health Sciences; Queen's University; Kingston ON Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - Michal Abrahamowicz
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - Meytal A. Tsadok
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
| | - Shadi Rajabi
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
| | - Louise Pilote
- Division of Clinical Epidemiology; McGill University; Montreal QC Canada
- Division of General Internal Medicine; McGill University; Montreal QC Canada
| |
Collapse
|
17
|
|
18
|
Kairalla JA, Coffey CS, Thomann MA, Shorr RI, Muller KE. Adaptive designs for comparative effectiveness research trials. CLINICAL RESEARCH AND REGULATORY AFFAIRS 2014; 32:36-44. [PMID: 27773984 PMCID: PMC5074387 DOI: 10.3109/10601333.2014.977490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Medical and health policy decision makers require improved design and analysis methods for comparative effectiveness research (CER) trials. In CER trials, there may be limited information to guide initial design choices. In general settings, adaptive designs (ADs) have effectively overcome limits on initial information. However, CER trials have fundamental differences from standard clinical trials including population heterogeneity and a vaguer concept of a "minimum clinically meaningful difference". OBJECTIVE To explore the use of a particular form of ADs for comparing treatments within the CER trial context. METHODS We review the current state of clinical CER, identify areas of CER as particularly strong candidates for application of novel ADs, and illustrate potential usefulness of the designs and methods for two group comparisons. RESULTS ADs can stabilize power. The designs ensure adequate power for true effects are at least at clinically significant preplanned effect size, or when variability is larger than expected. The designs allow for sample size savings when the true effect is larger or when variability is smaller than planned. CONCLUSION ADs in CER have great potential to allow trials to successfully and efficiently make important comparisons.
Collapse
Affiliation(s)
- John A. Kairalla
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | | | | | - Ronald I. Shorr
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Keith E. Muller
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
| |
Collapse
|
19
|
National trends in hospitalizations for sickle cell disease in the United States following the FDA approval of hydroxyurea, 1998-2008. Med Care 2014; 52:612-8. [PMID: 24926708 DOI: 10.1097/mlr.0000000000000143] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) can suffer frequent hospital admissions for painful vasoocclusive crises. Hydroxyurea was approved by the FDA in 1998 to decrease the morbidity of SCD, but nationwide hospitalizations for SCD in the United States since 1998 have not been evaluated. We hypothesized that the availability of hydroxyurea for SCD would be associated with a decrease in hospitalizations for SCD over time. OBJECTIVE To assess trends in hospitalization and length-of-stay in hospital for SCD in the United States, 1998 through 2008. RESEARCH DESIGN Retrospective cohort study of SCD-related hospital discharges in the Nationwide Inpatient Sample of US hospital discharges. SUBJECTS All discharges in the Nationwide Inpatient Sample associated with a principal diagnosis of SCD in blacks, 1998 through 2008. MEASURES Trends in hospitalization rates and average length-of-stay in hospital for SCD. RESULTS We found 216 (95% confidence interval, 173.3-258.7) SCD-related hospitalizations per 100,000 US blacks in 1998 and 178.4 (95% confidence interval, 144.2-212.5) in 2008, but no consistent yearly decrease, 1998 through 2008 (P=0.30). Conversely, the length-of-stay in hospital in 1998 was 5.38 days and in 2008 was 5.18 days, an absolute change of 0.2 days and a downward trend that was statistically significant. CONCLUSIONS Between 1998 and 2008, there was not a steady decrease in hospitalization rates for the population of SCD in the United States. On the contrary, there was a decline in length-of-stay in hospital over this time. Hydroxyurea underuse is well documented. Efforts to increase hydroxyurea use may help to reduce hospitalization rates.
Collapse
|
20
|
Hara M, Sakata Y, Nakatani D, Suna S, Usami M, Matsumoto S, Sugitani T, Nishino M, Sato H, Kitamura T, Nanto S, Hamasaki T, Hori M, Komuro I. Comparison of 5-year survival after acute myocardial infarction using angiotensin-converting enzyme inhibitor versus angiotensin II receptor blocker. Am J Cardiol 2014; 114:1-8. [PMID: 24819900 DOI: 10.1016/j.amjcard.2014.03.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
Few studies have investigated whether angiotensin II receptor blocker (ARB) is a practical alternative to angiotensin-converting enzyme inhibitor (ACEI) for long-term use after acute myocardial infarction (AMI) in real-world practice in the percutaneous coronary intervention era. We compared 5-year survival benefits of ACEI and ARB in patients with AMI registered in the Osaka Acute Coronary Insufficiency Study. Study subjects were divided into 3 groups: ACEI (n = 4,425), ARB (n = 2,158), or patients without either drug (n = 2,442). A total of 661 deaths were recorded. Cox regression analysis revealed that treatment with either ACEI or ARB was associated with reduced 5-year mortality (adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58 to 0.83, p <0.001 and HR 0.79, 95% CI 0.64 to 0.98, p = 0.03, respectively). However, Kaplan-Meier estimates and Cox regression analyses based on propensity score revealed that ACEI was associated with better survival than ARB from 2 to 5 years after survival discharge (adjusted HR 0.53, 95% CI 0.38 to 0.74, p <0.001). These findings were confirmed in a propensity score-matched population. In conclusion, treatment with ACEI was associated with better 5-year survival after AMI.
Collapse
Affiliation(s)
- Masahiko Hara
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaya Usami
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Sen Matsumoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshifumi Sugitani
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Hiroshi Sato
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshimitsu Hamasaki
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatsugu Hori
- Osaka Prefectural Hospital Organization, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
21
|
Rana BK, Dhamija A, Panizzon MS, Spoon KM, Vasilopoulos T, Franz CE, Grant MD, Jacobson KC, Kim K, Lyons MJ, McCaffery JM, Stein PK, Xian H, O'Connor DT, Kremen WS. Imputing observed blood pressure for antihypertensive treatment: impact on population and genetic analyses. Am J Hypertens 2014; 27:828-37. [PMID: 24532572 DOI: 10.1093/ajh/hpt271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP), a heritable risk factor for many age-related disorders, is commonly investigated in population and genetic studies, but antihypertensive use can confound study results. Routine methods to adjust for antihypertensives may not sufficiently account for newer treatment protocols (i.e., combination or multiple drug therapy) found in contemporary cohorts. METHODS We refined an existing method to impute unmedicated BP in individuals on antihypertensives by incorporating new treatment trends. We assessed BP and antihypertensive use in male twins (n = 1,237) from the Vietnam Era Twin Study of Aging: 36% reported antihypertensive use; 52% of those treated were on multiple drugs. RESULTS Estimated heritability was 0.43 (95% confidence interval (CI) = 0.20-0.50) and 0.44 (95% CI = 0.22-0.61) for measured systolic BP (SBP) and diastolic BP (DBP), respectively. We imputed BP for antihypertensives by 3 approaches: (i) addition of a fixed value of 10/5mm Hg to measured SBP/DBP; (ii) incremented addition of mm Hg to BP based on number of medications; and (iii) a refined approach adding mm Hg based on antihypertensive drug class and ethnicity. The imputations did not significantly affect estimated heritability of BP. However, use of our most refined imputation method and other methods resulted in significantly increased phenotypic correlations between BP and body mass index, a trait known to be correlated with BP. CONCLUSIONS This study highlights the potential usefulness of applying a representative adjustment for medication use, such as by considering drug class, ethnicity, and the combination of drugs when assessing the relationship between BP and risk factors.
Collapse
Affiliation(s)
- Brinda K Rana
- Department of Psychiatry, University of California-San Diego, La Jolla, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
McDonald E, Freedman DM, Alexander BH, Doody MM, Tucker MA, Linet MS, Cahoon EK. Prescription diuretic use and risk of basal cell carcinoma in the nationwide U.S. radiologic technologists cohort. Cancer Epidemiol Biomarkers Prev 2014; 23:1539-45. [PMID: 24812037 DOI: 10.1158/1055-9965.epi-14-0251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND UV radiation (UVR) exposure is the primary risk factor for basal cell carcinoma (BCC). Although prescription diuretics have photosensitizing properties, the relationship between diuretic use and BCC remains unclear. METHODS Using data from the United States Radiologic Technologists Study, a large, nationwide prospective cohort, we assessed the relationship between diuretic use and first primary BCC while accounting for sun exposure history, constitutional characteristics, lifestyle factors, and anthropometric measurements for geographically dispersed individuals exposed to a wide range of ambient UVR. RESULTS After adjustment for potential confounders, we found a significantly increased risk of BCC associated with diuretic use [HR, 1.22; 95% confidence interval (CI), 1.07-1.38]. This relationship was modified by body mass index (P = 0.019), such that BCC risk was increased with diuretic use in overweight (HR, 1.43; 95% CI, 1.16-1.76) and obese individuals (HR, 1.43; 95% CI, 1.09-1.88), but not in normal weight individuals (HR, 0.99; 95% CI, 0.81-1.21). CONCLUSIONS Increased risk of BCC associated with diuretic use in overweight and obese participants may be related to higher dosages, longer duration of medication use, reduced drug metabolism, or drug interactions. IMPACT Future cohort studies should obtain more detailed information on medication use, consider factors that affect drug metabolism, and measure intermediate endpoints such as photosensitivity reactions.
Collapse
Affiliation(s)
- Emily McDonald
- Department of Epidemiology and Biostatistics, Indiana University, School of Public Health, Bloomington, Indiana; Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - D Michal Freedman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota, School of Public Health, Minneapolis, Minnesota
| | - Michele M Doody
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| |
Collapse
|
23
|
Chou CL, Chou CY, Hsu CC, Chou YC, Chen TJ, Chou LF. Old habits die hard: a nationwide utilization study of short-acting nifedipine in Taiwan. PLoS One 2014; 9:e91858. [PMID: 24637880 PMCID: PMC3956761 DOI: 10.1371/journal.pone.0091858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the nationwide trend of ambulatory prescriptions of short-acting nifedipine on a PRN (pro re nata) order over a fifteen-year period in Taiwan. METHODS The systematic sampling claims datasets (0.2% sampling ratio) of ambulatory care visits within Taiwan's National Health Insurance from 1997 to 2011 were analyzed. The prescriptions of short-acting capsule-form nifedipine on a PRN order were stratified by the patient's age, the prescribing physician's specialty, and the setting of healthcare facility for each year. RESULTS During the study period, 8,189,681 visits were analyzed. While the utilization rate of calcium channel blockers changed with time from 2.8% (13,767/489,636) in 1997 to 5.1% (31,349/614,719) in 2011, that of short-acting nifedipine were from 1.0% (n = 5,070) to 0.2% (n = 1,246). However, short-acting capsule-form nifedipine on a PRN order still existed (from 447 prescriptions in 1997 to 784 in 2011). More than one half of these PRN nifedipines were prescribed by the internists and to the elderly patients; almost four-fifths of PRN nifedipines were prescribed during non-emergent consultations. CONCLUSION The physicians in Taiwan still had the habit of prescribing short-acting nifedipines for PRN use. The reason for such practices and the impact on patients' health deserve attention.
Collapse
Affiliation(s)
- Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Yu Chou
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| |
Collapse
|
24
|
Mohan AV, Fazel R, Huang PH, Shen YC, Howard D. Changes in Geographic Variation in the Use of Percutaneous Coronary Intervention for Stable Ischemic Heart Disease After Publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial. Circ Cardiovasc Qual Outcomes 2014; 7:125-30. [DOI: 10.1161/circoutcomes.113.000282] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Clinical uncertainty is cited as a cause of geographic variation. However, little is known about the effect of comparative effectiveness research on variation. We examined whether geographic variation in the use of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) declined after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial.
Methods and Results—
We examined changes in utilization and geographic variation in 67 hospital referral regions using the State Inpatient Databases. We compared age- and sex-adjusted rates of PCI for SIHD before (2006) and after (2008) publication of the COURAGE trial and compared those with contemporaneous changes in PCI volume for acute coronary syndrome. A total of 272 659 PCIs for SIHD from 526 hospitals were included in the analysis. After the publication of the COURAGE trial, PCI volume for SIHD declined by 25% (
P
<0.001) and decreased by 12% for acute coronary syndrome (
P
<0.001). This was predominantly attributable to changes in hospital referral regions with the highest levels of utilization pre-COURAGE trial (35% decline in the highest tertile versus 18% in the lowest). As measured by the systematic component of variation, there was substantial geographic variation in the use of PCI for SIHD preceding the publication of the COURAGE trial. Variation declined by 28% (0.53 versus 0.40) after publication, but geographic variation remained higher for SIHD than acute coronary syndrome (0.40 versus 0.17).
Conclusions—
There was a substantial decline in the use of and geographic variation in PCI for SIHD after the publication of the COURAGE trial. However, geographic variation in the use of PCI for SIHD remained high.
Collapse
Affiliation(s)
- Arun V. Mohan
- From the Department of Medicine, Divisions of Hospital Medicine (A.M.) and Cardiology (R.F.), Emory University School of Medicine, Atlanta, GA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.-H.H.); Department of Economics, Naval Postgraduate School, Monterey, CA (Y.-C.S.); Associate Professor of Economics, Department of Economics, Naval Postgraduate School, Monterrey, CA (Y.-C.S.); Faculty Research Fellow, National Bureau of Economic Research, Cambridge, MA (Y.-C.S
| | - Reza Fazel
- From the Department of Medicine, Divisions of Hospital Medicine (A.M.) and Cardiology (R.F.), Emory University School of Medicine, Atlanta, GA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.-H.H.); Department of Economics, Naval Postgraduate School, Monterey, CA (Y.-C.S.); Associate Professor of Economics, Department of Economics, Naval Postgraduate School, Monterrey, CA (Y.-C.S.); Faculty Research Fellow, National Bureau of Economic Research, Cambridge, MA (Y.-C.S
| | - Pei-Hsiu Huang
- From the Department of Medicine, Divisions of Hospital Medicine (A.M.) and Cardiology (R.F.), Emory University School of Medicine, Atlanta, GA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.-H.H.); Department of Economics, Naval Postgraduate School, Monterey, CA (Y.-C.S.); Associate Professor of Economics, Department of Economics, Naval Postgraduate School, Monterrey, CA (Y.-C.S.); Faculty Research Fellow, National Bureau of Economic Research, Cambridge, MA (Y.-C.S
| | - Yu-Chu Shen
- From the Department of Medicine, Divisions of Hospital Medicine (A.M.) and Cardiology (R.F.), Emory University School of Medicine, Atlanta, GA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.-H.H.); Department of Economics, Naval Postgraduate School, Monterey, CA (Y.-C.S.); Associate Professor of Economics, Department of Economics, Naval Postgraduate School, Monterrey, CA (Y.-C.S.); Faculty Research Fellow, National Bureau of Economic Research, Cambridge, MA (Y.-C.S
| | - David Howard
- From the Department of Medicine, Divisions of Hospital Medicine (A.M.) and Cardiology (R.F.), Emory University School of Medicine, Atlanta, GA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (P.-H.H.); Department of Economics, Naval Postgraduate School, Monterey, CA (Y.-C.S.); Associate Professor of Economics, Department of Economics, Naval Postgraduate School, Monterrey, CA (Y.-C.S.); Faculty Research Fellow, National Bureau of Economic Research, Cambridge, MA (Y.-C.S
| |
Collapse
|
25
|
Arno PS, Viola D. Hypertension treatment at the crossroads: a role for economics? Am J Hypertens 2013; 26:1257-9. [PMID: 24048145 DOI: 10.1093/ajh/hpt171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Peter S Arno
- Political Economy Research Institute, University of Massachusetts-Amherst Amherst, Massachusetts; City University of New York Institute for Health Equity, Lehman College, Bronx, New York;
| | - Deborah Viola
- Department of Health Policy and Management, New York Medical College, Valhalla, New York
| |
Collapse
|
26
|
Phillips W, Piller LB, Williamson JD, Whittle J, Jafri SZA, Ford CE, Einhorn PT, Oparil S, Furberg CD, Grimm RH, Alderman MH, Davis BR, Probstfield JL. Risk of hospitalized gastrointestinal bleeding in persons randomized to diuretic, ACE-inhibitor, or calcium-channel blocker in ALLHAT. J Clin Hypertens (Greenwich) 2013; 15:825-32. [PMID: 24283598 DOI: 10.1111/jch.12180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/02/2013] [Accepted: 07/08/2013] [Indexed: 11/29/2022]
Abstract
Calcium channel blockers (CCBs) are an important class of medication useful in the treatment of hypertension. Several observational studies have suggested an association between CCB therapy and gastrointestinal (GI) hemorrhage. Using administrative databases, the authors re-examined in a post-hoc analysis whether the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants randomized to the CCB amlodipine had a greater risk of hospitalized GI bleeding (a prespecified outcome) compared with those randomized to the diuretic chlorthalidone or the angiotensin-converting enzyme inhibitor lisinopril. Participants randomized to chlorthalidone did not have a reduced risk for GI bleeding hospitalizations compared with participants randomized to amlodipine (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.92-1.28). Those randomized to lisinopril were at increased risk of GI bleeding compared with those randomized to chlorthalidone (HR, 1.16; 95% CI, 1.00-1.36). In a post-hoc comparison, participants assigned to lisinopril therapy had a higher risk of hospitalized GI hemorrhage (HR, 1.27; 95% CI, 1.06-1.51) vs those assigned to amlodipine. In-study use of atenolol prior to first GI hemorrhage was related to a lower incidence of GI bleeding (HR, 0.69; 95% CI, 0.57-0.83). Hypertensive patients on amlodipine do not have an increased risk of GI bleeding hospitalizations compared with those taking either chlorthalidone or lisinopril.
Collapse
|
27
|
Howard DH, Shen YC. Trends in PCI volume after negative results from the COURAGE trial. Health Serv Res 2013; 49:153-70. [PMID: 23829189 DOI: 10.1111/1475-6773.12082] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe trends in the use of percutaneous coronary intervention (PCI) following the COURAGE trial, which found that medical therapy is as effective as PCI for patients with stable angina. DATA SOURCES We used the National Hospital Discharge Survey; inpatient and outpatient discharge data from Florida, Maryland, and New Jersey; and the English Hospital Episode Statistics database. STUDY DESIGN We report trends in PCI volume by diagnosis (stable angina vs. unstable angina or AMI) before and after publication of the COURAGE trial. PRINCIPAL FINDINGS The number of PCIs in patients without a diagnosis of AMI or unstable angina in Florida, Maryland, and New Jersey declined from 48,000 in 2006 to 40,000 in 2008 (-17 percent). There was no change in the number of PCIs in patients with a diagnosis of AMI. We observed similar patterns in U.S. community hospitals. PCI volume did not decline in England. CONCLUSIONS PCI volume declined after publication of the COURAGE trial. The experience of the COURAGE trial suggests that comparative effectiveness research can lead to cost-saving changes in medical practice patterns. However, there are many patients with stable coronary disease who continue to receive PCI post-COURAGE.
Collapse
Affiliation(s)
- David H Howard
- Department of Health Policy and Management, Emory University, Atlanta, GA
| | | |
Collapse
|
28
|
Wong MCS, Tam WWS, Cheung CSK, Tong ELH, Sek ACH, Cheung NT, Yan BPY, Yu CM, Griffiths SM. Antihypertensive prescriptions over a 10-year period in a large Chinese population. Am J Hypertens 2013; 26:931-8. [PMID: 23591987 DOI: 10.1093/ajh/hpt049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND International guidelines recommending antihypertensive prescriptions for the management of hypertension have been published in the past decade. Beta-blocker use was discouraged by a significant body of evidence and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) were found more effective among younger patients. This study aims to evaluate the trends in prescription profiles in a large Chinese population because patterns of antihypertensive agent dispensation represent important information for physicians and policymakers. METHODS From clinical databases consisting of all patient records in the public health-care system of Hong Kong, we examined all antihypertensive prescriptions according to the drug classes (thiazide diuretics, alpha-blockers, beta-blockers, calcium channel blockers (CCBs), ACEIs, ARBs, fixed-dose combinations, and polytherapy (2, ≥3)) between 2001 and 2010. We retrieved >6.3 million prescription episodes for 223,287 patients. RESULTS The average age of the patients was 59.9 years (SD = 17.6), and 54.8% were women. According to prescription episodes, the most commonly prescribed medications were beta-blockers (31.7%) and CCBs (29.2%), followed by ACEIs (13.9%), thiazide diuretics (5.0%), and alpha-blockers (4.5%). Between 2001 and 2010, the prescription proportions of beta-blockers decreased from 41.5% to 21.5%, whereas that of ARBs increased from 0.5% to 1.0% (P < 0.001, χ(2) test for trend). It was found that the decline of beta-blockers (71.0% to 35.4%) and increase in ARB prescriptions (0.4% to 1.0%) were particularly marked among younger subjects aged <55 years. CONCLUSIONS These findings provided information on the prescription patterns of antihypertensive agents in a large Chinese population. It sets a future research direction to study the various reasons influencing these drug class-specific trends.
Collapse
Affiliation(s)
- Martin C S Wong
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Harman J, Walker ER, Charbonneau V, Akylbekova EL, Nelson C, Wyatt SB. Treatment of hypertension among African Americans: the Jackson Heart Study. J Clin Hypertens (Greenwich) 2013; 15:367-74. [PMID: 23730984 PMCID: PMC3683967 DOI: 10.1111/jch.12088] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 01/13/2023]
Abstract
Hypertension treatment regimens used by African American adults in the Jackson Heart Study were evaluated at the first two clinical examinations (2415 treated hypertensive persons at examination I [exam I], 2000-2004; 2577 at examination II [exam II], 2005-2008). Blood pressure (BP) was below 140/90 mm Hg for 66% and 70% of treated participants at exam I and exam II, respectively. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treatment targets were met for 56% and 61% at exam I and exam II, respectively. Persons with diabetes or chronic kidney disease were less likely to have BP at target, as were men compared with women. Thiazide diuretics were the most commonly used antihypertensive medication, and persons taking a thiazide were more likely to have their BP controlled than persons not taking them; thiazides were used significantly less among men than women. Although calcium channel blockers are often considered to be effective monotherapy for African Americans, persons using calcium channel blocker monotherapy were significantly less likely to be at target BP than persons using thiazide monotherapy.
Collapse
Affiliation(s)
- Jane Harman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD 20892-7936, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Howard D, Brophy R, Howell S. Evidence of no benefit from knee surgery for osteoarthritis led to coverage changes and is linked to decline in procedures. Health Aff (Millwood) 2013; 31:2242-9. [PMID: 23048105 DOI: 10.1377/hlthaff.2012.0644] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients and physicians may be reluctant to abandon widely used treatments that have been found to be ineffective. In 2002 and 2008 the New England Journal of Medicine published the results of clinical trials showing that arthroscopic debridement and lavage--surgical treatments to remove damaged tissue and debris--do not benefit patients with osteoarthritis of the knee. To determine whether the trials' publication was associated with changes in practice patterns, we examined ambulatory surgery data from Florida and found that the number of debridement and lavage procedures per 100,000 adults declined 47 percent between 2001 and 2010. The reduction translates into national savings of $82-$138 million annually. These reductions may be offset by increases in the use of other procedures. The results indicate that clinical trials of widely used therapies can lead to cost-saving changes in practice patterns.
Collapse
Affiliation(s)
- David Howard
- Department of Health Policy and Management, Emory University, Atlanta, Georgia, USA.
| | | | | |
Collapse
|
31
|
Chou CC, Lin WS, Kao TW, Chang YW, Chen WL. Adherence to Available Clinical Practice Guidelines for Initiation of Antihypertensive Medication in Patients With or Without Diabetes Mellitus and Other Comorbidities in Taiwan. J Clin Pharmacol 2013; 52:576-85. [DOI: 10.1177/0091270011398658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
32
|
Trends in Antihypertensive Medication Use and Blood Pressure Control Among United States Adults With Hypertension. Circulation 2012; 126:2105-14. [DOI: 10.1161/circulationaha.112.096156] [Citation(s) in RCA: 393] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background—
The monitoring of national trends in hypertension treatment and control can provide important insight into the effectiveness of primary prevention efforts for cardiovascular disease. The objective of this study was to examine recent trends in antihypertensive medication use and its impact on blood pressure control among US adults with hypertension.
Methods and Results—
A total of 9320 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey 2001 to 2010 were included in this study. The prevalence of antihypertensive medication use increased from 63.5% in 2001 to 2002 to 77.3% in 2009 to 2010 (
P
trend
<0.01). Most notably, there was a large increase in the use of multiple antihypertensive agents (from 36.8% to 47.7%,
P
trend
<0.01). Overall, the use of thiazide diuretics, β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers increased by 23%, 57%, 31%, and 100%, respectively. In comparison with monotherapy, single-pill combinations and multiple-pill combinations were associated with 55% and 26% increased likelihoods of blood pressure control, respectively. By the 2009 to 2010 time period, 47% of all hypertensive people and 60% of treated hypertensive people had blood pressure controlled. However, higher treated but uncontrolled hypertension rates continued to persist among older Americans, non-Hispanic blacks, diabetic people, and those with chronic kidney disease. Also, Mexican Americans with hypertension were still less likely to take antihypertensive medication than non-Hispanic whites with hypertension.
Conclusions—
Antihypertensive medication use and blood pressure control among US adults with hypertension significantly increased over the past 10 years. Combination therapy regimens can facilitate achievement of blood pressure goals.
Collapse
|
33
|
Obara T, Ohkubo T, Ishikura K, Shibamiya T, Ikeda U, Metoki H, Kikuya M, Mano N, Kuriyama S, Imai Y. Change of the Management of Treated Hypertensive Patients with or without Diabetes in Japan. Clin Exp Hypertens 2012; 35:79-86. [DOI: 10.3109/10641963.2012.732640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
34
|
Chen WL, Kao TW, Wang CC, Chang YW, Wu LW, Wahlqvist ML, Chou CC. Difference of antihypertensive prescribing between office- and hospital-based clinics in Taiwan. Int J Clin Pharm 2012; 34:710-8. [DOI: 10.1007/s11096-012-9664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
|
35
|
Lund BC, Ernst ME. The Comparative Effectiveness of Hydrochlorothiazide and Chlorthalidone in an Observational Cohort of Veterans. J Clin Hypertens (Greenwich) 2012; 14:623-9. [DOI: 10.1111/j.1751-7176.2012.00679.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
36
|
Al Khalaf MM, Thalib L, Doi SAR. Cardiovascular outcomes in high-risk patients without heart failure treated with ARBs: a systematic review and meta-analysis. Am J Cardiovasc Drugs 2012; 9:29-43. [PMID: 19178130 DOI: 10.1007/bf03256593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Angiotensin II type 1 receptor antagonists (ARBs) are widely used as a substitute for angiotensin-converting enzyme inhibitors (ACEIs) to treat patients without heart failure, but their effect on cardiovascular morbidity and mortality has not been clearly determined. A systematic review and meta-analysis was undertaken to determine the impact of ARBs on cardiovascular outcomes in high-risk patients without heart failure. METHODS A computerized literature search was carried out using PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE, from January 1990 to April 2008. The following search terms were used: 'hypertension', 'clinical trial', 'sartan', 'ARB', 'angiotensin receptor antagonist', 'losartan', 'candesartan', 'valsartan', 'irbesartan', 'eprosartan', 'telmisartan', 'olmesartan', 'coronary disease', 'coronary heart disease', 'myocardial infarction', 'cardiovascular disease', 'cerebrovascular disease', and 'stroke'. Criteria for inclusion of clinical trials in our meta-analysis were the use of a randomized control group not receiving an ARB and the availability of outcome data for any one of four endpoints: myocardial infarction (MI), stroke, cardiovascular death, and all-cause death (these were not always pre-specified endpoints in all trials). Out of 45 potentially relevant studies, 37 trials met the inclusion criteria. We tabulated all occurrences of these four adverse outcomes. RESULTS Homogenous subgroups were combined by means of a fixed-effects model, while heterogenous subgroups were not combined. In the subgroup without heart failure, ARBs, when compared with the control group, had an odds ratio of 1.09 (95% CI 1.00, 1.18; p = 0.05) for MI. Other endpoints, namely, cardiovascular death and all-cause death, did not reach statistical significance. There was a clear trend for fewer strokes in the ARB group, but these studies were clearly heterogenous, and therefore a pooled risk estimate was not computed. CONCLUSION After pooling more than 89 000 patients, there is no evidence to suggest that ARBs confer cardiovascular protection akin to ACEIs, and the results that emerged are not in favor of ARB therapy in terms of its use as a substitute for ACEIs in non-heart failure patients. ARBs may have a small benefit in terms of stroke risk, but the studies are heterogenous, making it very difficult to quantify this effect. Given that ACEIs protect against both stroke and MI, caution is advised in the use of ARBs as a substitute for ACEIs in patients without a heart failure indication, who are tolerant of an ACEI.
Collapse
|
37
|
Krousel-Wood M, Muntner P, Carson A, Anderson AH, Delaune E, Cushman WC, Cutler JA, Piller LB, Goforth GA, Whelton PK. Hypertension control among newly treated patients before and after publication of the main ALLHAT results and JNC 7 guidelines. J Clin Hypertens (Greenwich) 2012; 14:277-83. [PMID: 22533653 DOI: 10.1111/j.1751-7176.2012.00609.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Medication prescribing practice changed following the publications of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) in 2002 and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) in 2003. Few data are available on changes in hypertension control rates for patients initiating antihypertensive treatment before and after these publications. The authors compared systolic and diastolic blood pressure (SBP and DBP) levels and hypertension control (SBP <140 mm Hg and DBP <90 mm Hg) rates in patients initiating antihypertensive treatment in a large managed care organization during 2 time periods: July 1, 2001, to June 30, 2002 (n=322); and July 1, 2003, to June 30, 2004 (n=323). The blood pressure reduction associated with antihypertensive medication initiation was similar in 2001-2002 and 2003-2004 (-11.9 and -10.5 mm Hg, respectively, P=.251 for SBP; -6.9 and -5.9 mm Hg, respectively, P=.160 for DBP). The mean SBP and DBP prior to treatment were significantly lower in 2003-2004 vs 2001-2002 (145.4 vs 151.3 mm Hg, P<.001 for SBP; 87.6 vs 90.1 mm Hg, P<.002 for DBP). Hypertension control rates increased from 38.0% to 50.2% (P=.005) from 2001-2002 to 2003-2004. Lower pretreatment SBP and DBP explained hypertension control improvement over time. In this real-world clinic population, antihypertensive treatment was initiated at lower blood pressure levels following publication of ALLHAT and JNC 7, resulting in substantial improvements in hypertension control rates.
Collapse
Affiliation(s)
- Marie Krousel-Wood
- Ochsner Clinic Foundation and Tulane University, New Orleans, LA 70121, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Howard DH, Shen YC. Comparative Effectiveness Research, Technological Abandonment, and Health Care Spending. THE ECONOMICS OF MEDICAL TECHNOLOGY 2012; 23:103-21. [DOI: 10.1108/s0731-2199(2012)0000023007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
39
|
|
40
|
Tomlinson B, Dalal JJ, Huang J, Low LP, Park CG, Rahman AR, Reyes EB, Soenarta AA, Heagerty A, Follath F. The role of β-blockers in the management of hypertension: an Asian perspective. Curr Med Res Opin 2011; 27:1021-33. [PMID: 21410302 DOI: 10.1185/03007995.2011.562884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Following publication of the National Institute of Clinical Excellence (NICE) Guidelines in 2006, the use of β-blockers as first-line therapy in hypertension has been somewhat controversial. However, a recent reappraisal of the European Society of Hypertension guidelines highlights that these agents exhibit similar BP lowering efficacy to other classes of agents, prompting a re-examination of the utility of these agents in various patient populations. The authors felt that it is important to address this controversy and provide an Asian perspective on the place of β-blockers in current clinical practice and the benefits of β-blockade in selected patient populations. In addition to their use as a potential first-line therapy in uncomplicated hypertension, β-blockers have a particular role in patients with hypertension and comorbidities such as heart failure or coronary artery disease, including those who had a myocardial infarction. One advantage which β-blockers offer is the additional protective effects in patients with prior cardiovascular events. Some of the disadvantages attributed to β-blockers appear more related to the older drugs in this class and further appraisal of the efficacy and safety profile of newer β-blockers will lend support to the current guideline recommendations in Asian countries and encourage increased appropriate use of β-blockade in current clinical practice within Asia.
Collapse
Affiliation(s)
- B Tomlinson
- Department of Medicine and Therapeutics; Division of Clinical Pharmacology, The Chinese University of Hong Kong, Hong Kong SAR.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Bhattacharyya OK, Estey EA, Zwarenstein M. Methodologies to evaluate the effectiveness of knowledge translation interventions: a primer for researchers and health care managers. J Clin Epidemiol 2011; 64:32-40. [DOI: 10.1016/j.jclinepi.2010.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 02/04/2010] [Accepted: 02/09/2010] [Indexed: 10/18/2022]
|
42
|
Stafford RS, Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Furberg CD, Piller LB, Pressel SL, Whelton PK. Impact of the ALLHAT/JNC7 Dissemination Project on thiazide-type diuretic use. ACTA ACUST UNITED AC 2010; 170:851-8. [PMID: 20498411 DOI: 10.1001/archinternmed.2010.130] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Strategies are needed to improve the translation of clinical trial results into practice. We assessed the impact of the ALLHAT/JNC7 Dissemination Project's academic detailing component on thiazide-type diuretic prescribing (ALLHAT indicates Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; JNC7 indicates the Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure). METHODS We used 2 national databases available from IMS Health: a physician survey of medications reported for hypertension and a pharmacy dispensing database on antihypertensive medications. At a county level, we correlated medication data with Dissemination Project intensity. Practices before the Dissemination Project in 2004 were compared with those after its completion in 2007. We also examined 2000-2008 national trends. RESULTS Academic detailing reached 18 524 physicians in 1698 venues via 147 investigator-educators. We noted an association between ALLHAT/JNC7 academic detailing activities and increased prescribing of thiazide-type diuretics. Physician survey data showed that the percentage of hypertension visits where the physician recorded a thiazide-type diuretic increased the most in counties where academic detailing activity was the highest (an increase of 8.6%, from 37.9% to 46.5%) compared with counties where activity was moderate (an increase of 2%) or low (a decrease of 2%), or where there was none (an increase of 2%; P value for trend, <.05). Pharmacy dispensing data showed that thiazide-type diuretic prescribing increased by 8.7% in counties with Dissemination Project activities compared with 3.9% in those without activities (P < .001). Nationally, thiazide-type diuretic use did not increase between 2004 and 2008. CONCLUSIONS The ALLHAT/JNC7 Dissemination Project was associated with a small effect on thiazide-type diuretic use consistent with its small dose and the potential of external factors to diminish its impact. Academic detailing may increase physicians' implementation of clinical trial results, thereby making prescribing more consistent with evidence.
Collapse
Affiliation(s)
- Randall S Stafford
- Programon Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Windak A, Gryglewska B, Tomasik T, Narkiewicz K, Yaphe J, Grodzicki T. Competence of Polish primary-care doctors in the pharmacological treatment of hypertension. J Eval Clin Pract 2010; 16:25-30. [PMID: 20367812 DOI: 10.1111/j.1365-2753.2008.01107.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Compliance with treatment guidelines for hypertension is variable. This study assessed the competence of Polish general practitioners in compliance with hypertension treatment guidelines, and doctor and patient characteristics associated with compliance. METHODS The study was conducted on a random sample of Polish primary-care doctors working in clinics contracted by the national health insurance funds. Doctors completed a questionnaire consisting of eight case vignettes describing patients with elevated blood pressure. The cases differed on three variables relating to the level of blood pressure, the presence or absence of diabetes mellitus, and the presence or absence of other risk factors. Doctors were asked to give their treatment decision for each case. Demographic data and details of the doctor's practice were also collected. Treatment decisions were tabulated, and associations between doctor and patient characteristics and treatments were assessed. RESULTS One hundred twenty-five doctors (65% response rate) completed the questionnaire. Compliance with treatment guidelines was judged to be 51%. Poor compliance with guidelines was noted for patients with diabetes mellitus. The level of blood pressure was the strongest predictor of drug treatment. Angiotensin-converting enzyme inhibitors were the most frequently prescribed medications. Appropriate decisions were associated with practice in large cities. CONCLUSIONS Compliance with hypertension treatment guidelines was judged to be poor in this study of a sample of Polish primary-care doctors using case vignettes to test competence. Additional emphasis on hypertension guidelines in training doctors is needed, especially for diabetic patients and for doctors outside urban centres.
Collapse
Affiliation(s)
- Adam Windak
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland.
| | | | | | | | | | | |
Collapse
|
44
|
Maio V, Gagne JJ. Impact of ALLHAT publication on antihypertensive prescribing patterns in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2010; 35:55-61. [DOI: 10.1111/j.1365-2710.2009.01047.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
45
|
Neutel JM. Choosing among renin-angiotensin system blockers for the management of hypertension: from pharmacology to clinical efficacy. Curr Med Res Opin 2010; 26:213-22. [PMID: 19921961 DOI: 10.1185/03007990903444434] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypertension is an important healthcare challenge, yet despite initiatives to improve detection and advances in therapy, the majority of patients do not achieve recommended blood pressure targets and remain at high cardiovascular risk. Physicians are confronted with an array of antihypertensive agents, accompanied by increasingly complex and often conflicting evidence regarding their efficacy and tolerability. SCOPE An extensive PubMed and Cochrane database search was conducted to identify clinical literature (published 1990-2009) on the blood pressure lowering efficacy, tolerability and target organ protection of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). While not a systematic review, this article reviews the best available evidence in an attempt to clarify current uncertainty within medical practice regarding treatment options in patients with hypertension. FINDINGS ACEIs have been at the forefront of hypertension therapy for several years, especially in hypertensive at-risk patients. However, their use is restricted by burdensome side-effects and their limited ability to reach target blood pressure. Newer ARBs, such as telmisartan, have more sustained blood pressure control throughout the 24-h dosing period compared with ACEIs and other ARBs. For uncomplicated hypertension, ARBs are preferred to ACEIs because of their superior tolerability and adherence. In specific patient populations, namely heart failure patients, ARBs have previously shown equal cardiovascular protection to ACEIs. ONTARGET showed that an ARB, in this case telmisartan, was as effective as ramipril in reducing cardiovascular events in a wide cross-section of at-risk cardiovascular patients, but was better tolerated even though patients were screened for ACEI tolerance. CONCLUSION Telmisartan is currently the only ARB to have demonstrated equivalence to ramipril in reducing cardiovascular events in a broad patient population. In practical terms, telmisartan is superior to the reference standard ramipril because of more powerful blood pressure lowering and superior tolerability. However, in many countries, guidance to physicians prioritizes ACEIs. In these countries, telmisartan should be the first choice ARB for hypertensive at-risk patients who do not achieve adequate blood pressure control with an ACEI, or for whom tolerability is a concern.
Collapse
Affiliation(s)
- J M Neutel
- Orange County Research Center, Tustin, CA 92780, USA.
| |
Collapse
|
46
|
Highlander P, Shaw GP. Current pharmacotherapeutic concepts for the treatment of cardiovascular disease in diabetics. Ther Adv Cardiovasc Dis 2009; 4:43-54. [PMID: 19965897 DOI: 10.1177/1753944709354305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With the growing worldwide obesity epidemic, obesity, type 2 diabetes mellitus and hypertension leading to premature cardiovascular events, are increasingly prevalent. Diabetes mellitus is a significant public health concern and more aggressive management of the condition and its complications, particularly cardiovascular disease, is warranted. Endothelial cell dysfunction is now known to be present at the earliest stages of metabolic syndrome, and insulin resistance and may precede the clinical diagnosis of type 2 diabetes mellitus by several years. The current focus on endothelial cell function as a potential target of pharmacotherapy in the management of cardiovascular disease in diabetics seems warranted, though not all drugs currently prescribed target endothelial cell function equally. In this review, we consider the six classes of drugs currently prescribed for the treatment of hypertension as they impact endothelial cell function and advocate for the development of novel drugs that can repair the endothelium and enhance nitric oxide availability thus preventing future cardiovascular events.
Collapse
Affiliation(s)
- Peter Highlander
- School of Podiatric Medicine, Barry University, Miami Shores, FL, USA
| | | |
Collapse
|
47
|
Delaney JAC, McClelland RL, Furberg CD, Cooper R, Shea S, Burke G, Psaty BM. Time trends in the use of anti-hypertensive medications: results from the Multi-Ethnic Study of Atherosclerosis. Pharmacoepidemiol Drug Saf 2009; 18:826-32. [PMID: 19551700 DOI: 10.1002/pds.1788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous reports have suggested that new evidence of the comparative effectiveness of different medication classes from randomized controlled trials (RCTs) does not always alter treatment decisions for first-line anti-hypertensive therapy. OBJECTIVES To evaluate the association of RCT evidence in December 2002 from the Anti-hypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) on use of anti-hypertensive medications in a multi-ethnic cohort. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) study, a prospective cohort study of 6814 adults from four ethnic groups, had four separate assessments of drug use. Users of anti-hypertensive medications at baseline were excluded. We evaluated temporal changes in the medication class reported by new users of anti-hypertensive medications. RESULTS After the exclusion of anti-hypertensive drug users at baseline, 32% of new users of anti-hypertensive drugs seen at exam 2 were prescribed a diuretic. The publication of ALLHAT was associated with a subsequent increase in the proportion of new users taking diuretics at exam 3 compared with exam 2 (relative risk (RR): 1.31; 95% confidence interval (CI): 1.09-1.59). After the report from ALLHAT, the proportion of users of diuretics seen at exam 3 rose to 44% (starting in 2004) and 39% in exam 4 (starting in 2005). This increase in the proportion of diuretic use among new users of anti-hypertensive medications declined slightly but could still be detected at exam 4 as compared to exam 2 (RR: 1.28; 95%CI: 1.04-1.57). CONCLUSIONS The randomized trial evidence from the ALLHAT study was temporally associated with a moderate increase in diuretic use.
Collapse
Affiliation(s)
- Joseph A C Delaney
- Department of Biostatistics, University of Washington, Seattle, WA 98115, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Graumlich JF, Piller LB, Pressel S, Roccella EJ, Simpson L, Whelton PK, Williard A, Allhat Collaborative Research Group. Getting clinical trial results into practice: design, implementation, and process evaluation of the ALLHAT Dissemination Project. Clin Trials 2009; 6:329-43. [PMID: 19587068 PMCID: PMC2897824 DOI: 10.1177/1740774509338234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Conventional dissemination of clinical trial results has inconsistent impact on physician practices. A more comprehensive plan to influence determinants of prescribing practices is warranted. PURPOSE To report the response from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial to the National Heart, Lung, and Blood Institute's requirement for dissemination and evaluation of trials with potential immediate public health applicability. METHODS ALLHAT's dissemination plan had two-components: (1) a traditional approach of media coverage, scientific presentation, and publication; and (2) a theory-based approach targeting determinants of clinician behavior. Strategies included: (1) academic detailing, in which physicians approach colleagues regarding blood pressure management, (2) direct patient messages to stimulate communication with physicians regarding blood pressure control, (3) approaches to formulary systems to use educational and economic incentives for evidence-based prescription, and (4) direct professional organization appeals to clinicians. RESULTS One hundred and forty-seven Investigator Educators reported 1698 presentations to 18,524 clinicians in 41 states and the District of Columbia. The pre- and post-test responses of 1709 clinicians in the face-to-face meetings indicated significant changes in expectations for positive patient outcomes and intention to prescribe diuretics. Information was mailed to 55 individuals representing 20 professional organizations and to eight formulary systems. Direct-to-patient messages were provided to 14 sites that host patient newsletters and Web sites such as health plans and insurance companies, 62 print mass media outlets, and 12 broadcast media sites. LIMITATIONS It was not within the scope of the project to conduct a randomized trial of the impact of the dissemination. However, impact evaluation using quasi-experimental designs is ongoing. CONCLUSION A large multi-method dissemination of clinical trial results is feasible. Planning for dissemination efforts, including evaluation research, should be considered as a part of the funding and design of the clinical trial and should begin early in trial planning.
Collapse
Affiliation(s)
- L Kay Bartholomew
- University of Texas Health Science Center - Houston, School of Public Health, Houston, TX, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
McAlister FA, Feldman RD, Wyard K, Brant R, Campbell NRC. The impact of the Canadian Hypertension Education Programme in its first decade. Eur Heart J 2009; 30:1434-9. [PMID: 19454575 DOI: 10.1093/eurheartj/ehp192] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, 8440 112 Street, Edmonton, AB, Canada.
| | | | | | | | | | | |
Collapse
|
50
|
Carter BL. Preventing thiazide-induced hyperglycemia: opportunities for clinical pharmacists. Pharmacotherapy 2009; 28:1425-8. [PMID: 19025422 DOI: 10.1592/phco.28.12.1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|