Abstract
Hypertension requires strict treatment because it causes diseases that can lead to death. Although various classes of antihypertensive drugs are available, the actual status of antihypertensive drug selection and the transition in prescription patterns over time have not been fully examined. Therefore, we conducted a claims-based study using two claims databases (2008–16) to determine this status in Japan. We examined the prescription rate for each class of antihypertensive drugs in hypertensive patients and compared the patients’ ages and the sizes of the medical institutions treating these patients. Among the 1 560 865 and 302 433 hypertensive patients in each database, calcium channel blockers (CCBs) (>60%) and angiotensin II receptor blockers (ARBs) (>55%) were the most frequently prescribed classes. The prescription rate of CCBs increased and ARBs decreased with the patients’ ages. Although the Japanese guidelines for management of hypertension in 2014 changed the recommendation and indicated that β-blockers should not be used as first-line drugs, their prescription status did not change during this study period up to 2016. Use of CCBs and ARBs as first-line drugs differed by the types of patient comorbidities. Although ARBs or angiotensin-converting enzyme inhibitors were recommended for patients with some comorbidities, CCBs were used relatively frequently. In conclusion, the patients’ ages and comorbidities and the sizes of the medical institutions affect the selection of antihypertensive drugs. Selection and use of drugs may not always follow the guidelines.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Sustained high blood pressure causes the development, progression, and recurrence of various cardiovascular diseases
We defined the class of drugs initially prescribed as a single drug class following a 6-month period during which no antihypertensive drug prescription was recorded as a first-line class in the Japan Medical Data Center (JMDC) database
The prescription rate of each class as the first-line drug was calculated by dividing the number of patients who were initially prescribed a class of antihypertensive drugs, including a single class and a combination of two or more classes at once, by the number of patients who were initially prescribed any class of antihypertensive drugs
Summary
Sustained high blood pressure causes the development, progression, and recurrence of various cardiovascular diseases. High blood pressure leads to a decrease in quality of life [1] and an increase in the risk of death [2, 3]. Antihypertensive treatments are administered to reduce such risks. Lifestyle modification is advised as a primary treatment. When the target blood pressure cannot be achieved by these modifications, antihypertensive drug therapy is required [4,5,6]
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