Cost Of Antihypertensive Drugs Research Articles

Cost Minimization Analysis (CMA) Penggunaan Obat Captopril dan Lisinopril pada Pasien Hipertensi di RSUD Sultan Suriansyah Banjarmasin

Hypertension is a world health problem leading to increased morbidity and mortality, as well as burdening the cost of health services, including in Indonesia. Cost Minimal hypertension treatment can reduce the high incidence of hypertension. The purpose of this study was to determine the cost that is more cost-minimize among the use of captopril and lisinopril in outpatient hypertension patients at Sultan Suriansyah Hospital Banjarmasin. This study is an analytic with a design cross sectional. Data collection is done by looking at the medical records of hypertensive patients outpatient hospital Sultan Suriansyah Banjarmasin who received antihypertensive therapy captopril and lisinopril. The sampling method used is non-probability sampling by using the technique purposive non-random sampling. Samples that 35 patients were used. The cost component measured is direct medical costs outpatient hypertensive patients which includes the cost of antihypertensive drugs, the cost of disease drugs participants, laboratory fees, and consulting fees. The results showed that the average total direct medical cost in the captopril group was Rp127.886 and the group lisinopril Rp.274.971. In the captopril group it has a more minimal cost compared with the lisinopril group.

DIRECT MEDICAL COST AND LENGTH OF STAY OF HYPERTENSION PATIENTS AT PRIVATE HOSPITAL IN YOGYAKARTA

The province that ranks fourth with the highest incidence of hypertension in Indonesia is the Special Region of Yogyakarta (DIY). Hypertension therapy is carried out in a not short period, so it becomes an economic burden for people with hypertension and the government. This study aims to determine the relationship between the length of hospitalization and direct medical costs—an analytical observational research method with retrospective data collection and data from class III inpatient hypertensive medical records. The calculation of costs is viewed from a payer's perspective—descriptive and analytical data analysis to determine the relationship between the length of hospitalization and direct medical costs. The study's results of 41 patients met the criteria; 53.65% were women aged 22-59 years (53.65%). The most widely used antihypertensive drug was the combination of amlodipine + candesartan (26.82%). The average direct medical costs for hypertensive patients were IDR 7,039,515. The highest direct medical cost component is the cost of other drugs and medical equipment. The component of direct medical costs is the lowest cost of antihypertensive drugs. The average length of hospitalization for hypertensive patients is 6.14 days. There was a significant relationship (p=0.000) between the length of hospitalization and direct medical costs. The conclusion of this study is a significant relationship (p = 0.000) between the length of hospitalization and direct medical costs

Essential medicines and technology for hypertension in primary healthcare facilities in Ebonyi State, Nigeria.

Cardiovascular diseases (CVDs) now constitute major cause of morbidity and mortality in middle and low income countries including Nigeria. One of the major efforts at controlling CVDs in Nigeria includes expanding universal access to care through the primary healthcare (PHC) system. The study was to assess essential medicines and technology for control of hypertension in PHC facilities in Ebonyi Nigeria. The study used mixed method cross-sectional survey to assess availability, affordability and accessibility of essential medicines and technology in 45 facilities and among their patients with hypertension (145). Most of the PHC facilities (71.1%) assessed were rural. The heads of facilities were mainly community health extension workers (86.7%). One (2.2%) facility had a pharmacy technician. All facilities had been supervised by the regulatory authority in the last one year. Out of 15 anti-hypertensive drugs assessed, 10 were available in some facilities (2.2%-44.4%) but essential drug availability was low (<80%). Only mercury sphygmomanometers were available in all facilities with 82.2% functioning. Stethoscopes were available in all facilities and 95.6% were functional. Glucometers were present in 20.0% of facilities and were all functional. All the respondents (100.0%) reported they could not afford their anti-hypertensive drugs. Median monthly income was 8,000 Nigerian Naira (range = 2,000-52,000). Median monthly cost of anti-hypertensive drugs was 3,500 Naira (range = 1,500-10,000). For 99 (68.3%) of the respondents, the facilities were accessible. Median cost of transportation for care was 400 Naira (range = 100-2,000). Gaps still exist in the provision of hypertension control services in PHC facilities in Ebonyi State, Nigeria. The essential drugs were not always available, and cost of the drugs were still a challenge to the patients. There is urgent need to expand health insurance coverage to rural communities to ameliorate the catastrophic out-of-pocket health expenditures and improve control of CVDs.

DRUG COST OF OUTPATIENT TREATMENT FOR HYPERTENSION AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Hypertension is a common disease in the world as well as in Vietnam, a great threat to human health. With the number of people suffering from hypertension constantly increasing, the cost of treatment for this chronic disease is a dilemma that not only affects patients directly, but also a burden to society. The study was conducted to contribute to the analysis of the current outpatient drug costs for hypertensive patients. Materials and method: Conducted restropective study. Data was collected outpatient drug payment information for hypertensive patients in 2018. There were 1805 outpatient treatment sessions from 1-6/2018 included in the analysis. Results: The average drug cost of an outpatient treatment course for hypertension is 339,088 ± 257,021 VND. Imported drugs accounted for 80.69% of the total cost and 90.48% of the outpatient treatment course. The cost of antihypertensive drugs accounted for 38.21% of the total drug cost, and the drugs with the highest cost were brand-name drugs. Conclusion: The average drug cost of the treatment course of hypertensive patients with complications/comorbidities was significantly higher than that of patients with hypertension alone. Imported drugs and brand-name drugs account for a large proportion of drug costs for hypertensive outpatients. Key words: drug cost, hypertension, outpatient, Hue University of Medicine and Pharmacy Hospital.

Fixed Versus Free Combinations Of Antihypertensive Drugs: Analyses Of Real-World Data Of Persistence With Therapy In Italy.

PurposeTo analyse the pattern of use and cost of antihypertensive drugs in new users in an Italian population, and explore the patient/treatment factors associated with the risk of therapy discontinuation.Patients and methodsIn this retrospective study, information was collected from a population-based electronic primary-care database. Persistence with medication use 1 year from therapy initiation was evaluated for each user using the gap method. Each new user was classified according to his/her pattern of use as: “continuer”, “discontinuer” “switching” or “add-on”. A Cox regression model was used to analyse the factors influencing therapy discontinuation. Primary-care costs comprised specialists’ visits, diagnostic procedures and pharmacologic therapies.ResultsAmong 14,999 subjects included in persistence analyses, 55.1% of cases initially started on monotherapy were classified as discontinuers vs 36.5% of cases taking combination therapy (42.3% vs 32.7%, respectively, for free and fixed combinations, P < 0.01). Old age, high cardiovascular risk and being in receipt of fixed-combination therapy were associated with greater persistence. Overall, the primary-care cost/person/year of hypertension management was ~€95.3 (IQR, 144.9). The monotherapy cost was €88 per patient (IQR, 132.9), and that for combination therapy was €151±148.3. The median cost/patient with a fixed combination was lower than that for a free combination (€98.4 (IQR, 155.3) and €154.9 (IQR, 182.6), respectively).ConclusionThe initial type of therapy prescribed influences persistence. Prescribing fixed combinations might be a good choice as initial therapy.

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia

BackgroundUncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia).MethodsA historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated.ResultsMore than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95–0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5–201.8) Croatian kunas and was similar across the study sites.ConclusionMultiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.

Drug utilization pattern of antihypertensive agents in patients of hypertensive nephropathy in a tertiary care hospital: a cross sectional study

Background: Objective of the study was to determine the drug utilization pattern of antihypertensive agents in patients of hypertensive nephropathy in a tertiary care teaching hospital.Methods: This was a prospective observational study carried out in Index medical college and Hospital, Indore over a period of three 4 months. A total of 60 patients aged 40-79 years taking treatment for hypertension with associated nephropathy were enrolled in the study. All the relevant data were collected and drug utilization pattern of antihypertensive agents was determined. The study evaluated the percentage of use of multidrug therapy, drugs prescribed from Essential Drug List (EDL) and prescriptions with generic name. The cost of antihypertensive drugs used per day was calculated and linked with socioeconomic status of the patients.Results: Evaluation of the prescriptions demonstrates that a total of 63.3% males and 36.7% females with mean age of 58.9±11.9 years were enrolled out of which 70% patients were on multidrug therapy while only 30% were on monotherapy. Though only 16.67% patients were prescribed generic drugs but it did not affect the economic condition of the patient as most of enrolled patients belong to upper middle class.Conclusions: The prescriptions analysed were in accordance to guidelines of JNC-8 (Joint National Committee - 8) and most of the prescriptions were found to be rational and it also shows that management of hypertensive nephropathy needs combination therapy.

Cost variation analysis of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation

Background: Several brands of antihypertensive drugs are available in the Indian market with huge price variations. This study was undertaken to find out the percentage cost variation and cost ratio of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation.Methods: Costs of different brands of renin angiotensin aldosterone axis modulatory drugs with antihypertensive action for the same dosage form and strength were found out using current index of medical specialties-134, July-October 2016. The maximum and minimum price of different brands of each drug was noted. Data was entered in Microsoft excel 2010. Percentage cost variation and cost ratio was calculated for each drug.Results: 16 antihypertensive drugs were analysed. Most of them were tablets. Ramipril and Valsartan were available as capsules also. Among tablets, percentage cost variation was highest for Atenolol 12.5 mg (683.93%) and least for Bisoprolol 2.5 mg (3.6538%). Valsartan capsules (160 mg) had no difference in the costs between the available 2 brands. Cost ratio ranged from 1.04 to 7.84 among the tablet form of drugs.Conclusions: There is a huge difference in the cost of antihypertensive drugs manufactured by different companies in the same strength and dosage form. To promote rational drug use and cost effective therapy, it is essential to create an awareness among clinicians regarding the availability of multiple brands for these drugs and the discrepancies in their costs.

Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea

ObjectivesTo evaluate the quantitative effects of the drug price reduction on pharmaceutical expenditures and the new guidelines to restrict prescribing on drug utilisation for antihypertensive drugs.DesignWe used an interrupted time...

Trends and patterns of five antihypertensive drug classes between 2007 and 2012 in China using hospital prescription data.

To examine prescription trends and patterns in five antihypertensive drug classes during 2007 - 2012 in China. A retrospective time series data was investigated from 2007 to 2012. Prescription data of five classes of antihypertensive drugs (calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, and diuretics) were accessed from the Hospital Prescription Analysis Program Database, including 59 hospitals in four cities in China. The drugs were coded using the Anatomic Chemical Therapeutic (ATC) classification. Quantities were standardized using the defined daily dose (DDD) measurement methodology. The total number of DDDs of the five classes of antihypertensive drugs prescribed in the sample hospitals increased by 83.3% and the total cost of antihypertensive drugs increased by 92.4% from 2007 to 2012. During the whole study period, CCBs, ARBs, ACEIs, β-blockers, and diuretics represented in DDDs 42.8%, 28.3%, 13.3%, 10.8%, and 4.8%, respectively, of the total five classes of anti-hypertensive drugs. The average annual increase rate of ARBs, β-blockers, CCBs, ACEIs, and diuretics, in DDDs, was 23.4%, 13.3%, 13.2%, 1.4%, and -4.2%, respectively The consumption of the five classes of antihypertensive drugs in China nearly doubled from 2007 to 2012. The top-prescribed antihypertensive drug classes were CCBs and ARBs, and the latter increased most rapidly.

Influential factors of treatment cost of antihypertensive drugs for hypertensive patient in community

To explore the influential factors of treatment cost of antihypertensive drugs for hypertensive patient in community. A total of 220 community health centers (CHCs) from 15 provinces were selected across China in view of geographical location, economic level and previous cooperative experience to implement standardized blood pressure management for hypertensive patients for 1 year, based on guidelines for prevention and control for hypertension in China (2009 Community-based revision). Baseline and follow-up information for each hypertensive patient under the care of these CHCs was collected. A total of 22 683 hypertensive patients in hypertension community standardization management were enrolled in this study. We used multivariate linear regression model to analyze the influential factors of treatment cost of antihypertensive drugs. Cultural degree, regional distribution, medical security system, the blood pressure classification, complications, and treatment options were statistically significant independent variables. In hypertension community standardization management, the blood pressure of hypertensive patients should be controlled in advance to reduce the economic burden, , the occurrence of complications should be reduced, and economic factors should also be considered when selecting a treatment option.

Pharmacoeconomics of antihypertensive drugs prescribed in a multispecialty hospital in South India

The main objective of this study is to evaluate the most cost‑effective therapy among the different group of antihypertensive prescribed in a multispecialty hospital. According to inclusion and exclusion criteria, 104 hypertensive patients were selected. Participants were interviewed at about the demographic data. Initial clinical assessment of blood pressure (BP) and pulse rate were done. They were prescribed monotherapy either with angiotensin receptor blocker (ARB) (n = 7) or beta blocker (BB) (n = 23) or calcium channel blocker (CCB) (n = 9). Angiotensin converting enzyme with BB (n = 27), ARB with CCB (n = 17) and ARB with BB (n = 21) were prescribed in combination therapy. The cost of antihypertensive drugs was calculated using incremental cost for “per mmHg” reduction and cost for “per patient” reaching target BP. The data are analyzed using suitable statistical methods. ARB with BB shows significant reduction in BP. To maintain the targeted BP, BB is found to be cost‑effective in both systolic BP (SBP) and diastolic BP (DBP) as well as in the reduction of “per mmHg” of DBP. In case of reduction of “per mmHg” of SBP ARB is cost‑effective. Treatment of hypertension with BBs is cost‑effective. Key words: Antihypertensive drugs, beta blockers, cost effectiveness

PCV46 - Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: A retrospective cost analysis

The prescription of fixed-dose combinations (FDC) of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction. In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs. Claims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers (ARBs). Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC (control group). Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers’ characteristics. There were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers’ characteristics. The switch to FDC was associated with an annual saving of 10,420 yen (US$112.0) in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen (US$25.5). For hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs.

Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis

BackgroundThe prescription of fixed-dose combinations (FDC) of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction.In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs.MethodsClaims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers (ARBs). Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC (control group). Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers’ characteristics.ResultsThere were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers’ characteristics. The switch to FDC was associated with an annual saving of 10,420 yen (US$112.0) in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen (US$25.5).ConclusionsFor hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs.

Prescribing Patterns and Cost of Antihypertensive Drugs in Private Hospitals in Dar es Salaam, Tanzania

Antihypertensive agents are used to prevent morbidity and mortality related to hypertension. Prescribing patterns and the cost of some antihypertensive were studied for 600 patients attending medical clinics in four private hospitals in Dar es Salaam using the WHO drug use indicator forms. The average number of drugs per prescription ranged from 1.9 to 4.2 while that of antihypertensives varied from 1.3 to 2.1. About 50 % of the prescriptions contained 2 to 3 drugs. The most frequently prescribed antihypertensives were diuretics (41 %), &beta;-blockers (28.5 %), calciumchannel blockers (19.8 %), hydralazine/losartan (18.5 %) and angiotensinconverting enzyme inhibitors (11.5 %). Antihypertensives prescribed asmonotherapy included atenolol (23.2 %), bendrofluazide (22 %), frusemide (19 %), hydralazine (11.2 %), nifedipine (9.8 %), amlodipine (9.5 %) and enalapril (9.3 %). Among the combination therapy drugs were angiotensin converting enzyme inhibitor+diuretic (7 %), &beta;-blocker+diuretic (4 %), calcium channel blocker+losartan (2.3 %), &beta;-blocker+angiotensin converting enzyme inhibitor (2.2 %), calcium channel blocker+angiotensin converting enzyme inhibitor (1.8 %) and diuretic+hydralazine (1.7 %). The cost of nifedipine, bendrofluazide and frusemide was about five to six times higher in the private hospitals than at the governmentowned medical stores department. This study reveals a need for continuingeducation and standard treatment guidelines for rational prescribing ofantihypertensive drugs.

Estudio farmacoepidemiologico y farmacoeconomico de la hipertensión arterial

Pharmacologic treatment of arterial hypertension is complicated, as indicated by the elevated number of drugs offered by pharmaceutical companies and prescribed by medicine doctors. Arterial hypertension shows a high prevalence, specially in individuals aged 65 years or more. The prevalence of treated hypertensive patients in the Basque Country can be estimated in 108 per one thousand inhabitants. Preferentially used drugs for the treatment of arterial hypertension in the Basque Country are ECA inhibitors, specially enalapril, as well as angiotensin II antagonists. Economic cost of antihypertensive drugs in the Basque country reaches 72.050.133,02 euros. There are important differences in the price of analogous pharmaceutical preparations of the same drug. 6.463.400,35 euros could be saved, if the cheapest pharmaceutical preparations were selected.

Posting Guidelines: A Practical and Effective Way to Promote Appropriate Hypertension Treatment

Despite publication and periodic updating of treatment guidelines, hypertension remains undertreated in the United States, and physicians underuse recommended drugs. Hypertension treatment guidelines were summarized and posted in five places in a hospital-based primary care clinic staffed by internists and internal medicine residents. Costs and recommended doses of five commonly used antihypertensive drugs were included. The charts of all 253 patients seen during a four-month period with a diagnosis of hypertension were analyzed. Blood pressures and physician prescribing habits were compared at baseline and at 8, 12, and 16 months after posting the guidelines. The number of patients with blood pressures < 140/90 mm Hg increased from 41% to 58%, p = .001. Median (IQR) systolic pressure fell from 143 (119-167) to 137 (116-158) mm Hg, p < .0001 and diastolic pressure from 78 (65-91) to 77 (64-90) mm Hg, p = .0002. Physicians prescribed more recommended drugs, more total antihypertensive drugs, larger doses of hydrochlorothiazide and lisinopril, and more inexpensive drugs. The total cost of antihypertensive drugs per patient increased slightly. Regular exposure to clinical guidelines, presented in a practical and simple way, can change physician behavior and improve patient care.

Hypotensive Peptides from Milk Proteins

Hypertension is the major controllable risk factor associated with cardiovascular disease (CVD) events such as myocardial infarction, stroke, heart failure, and end-stage diabetes. A 5 mm Hg decrease in blood pressure has been equated with approximately 16% decrease in CVD. In the U.S. alone current annual antihypertensive drug costs are approximately dollars 15 billion. The renin-angiotensin-aldosterone system is a target for blood pressure control. Cleavage of angiotensinogen by renin produces angiotensin I which is subsequently hydrolyzed by angiotensin-I-converting enzyme (ACE) to angiotensin II (a potent vasoconstrictor). Various side effects are associated with the use of ACE inhibitory drugs in the control of blood pressure including hypotension, increased potassium levels, reduced renal function, cough, angioedema, skin rashes, and fetal abnormalities. Milk proteins, both caseins and whey proteins, are a rich source of ACE inhibitory peptides. Several studies in spontaneously hypertensive rats show that these casokinins and lactokinins can significantly reduce blood pressure. Furthermore, a limited number of human studies have associated milk protein-derived peptides with statistically significant hypotensive effects (i.e., lower systolic and diastolic pressures). The advent of effective milk protein based functional food ingredients/nutraceuticals for the prevention/control of blood pressure therefore has the potential to significantly reduce global healthcare cost.

Assessment of factors influencing blood pressure control in a managed care population.

We attempted to determine the percentage of patients meeting Health Plan Employer Data Information Set (HEDIS) criteria for blood pressure control (< or = 140/90 mm Hg), to identify factors contributing to differences in blood pressure control among those who met HEDIS criteria and those who did not, and to assess compliance with blood pressure management recommendations established by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) for diabetes mellitus and myocardial infarction. In this retrospective analysis, we randomly selected 502 patient records from three primary care clinics in southeast Michigan. All patients were commercial members of one health maintenance organization, 74% of whom met HEDIS criteria for blood pressure control. These patients took fewer blood pressure drugs throughout the year (p=0.023) and had lower antihypertensive drug costs than those who did not achieve HEDIS blood pressure goals (p=0.016). According to JNC-VI criteria, 46% of diabetic patients were at their blood pressure goal of below 130/85 mm Hg and 71.6% were managed with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Eighty-five percent of patients were taking beta-blockers after myocardial infarction. The percentage of patients achieving target blood pressure exceeded the national average and was associated with few antihypertensive drugs and low drug cost. Effective and appropriate management of blood pressure in people with diabetes remains a challenge.

Results of a pilot pharmacotherapy quality improvement program using fixed-dose, combination amlodipine/benazepril antihypertensive therapy in a long-term care setting

Background: Hypertension is common in older adults (aged ≥65 years). Treatment frequently requires multiple medications and can be expensive. Objective: This study measured the impact of substituting low-dose, fixed-combination therapy using the calcium channel blocker (CCB) amlodipine and the angiotensin-converting enzyme (ACE) inhibitor benazepril for high-dose CCB monotherapy or dual therapy with a CCB and an ACE inhibitor on antihypertensive drug costs, the incidence of adverse events, and blood-pressure control. Methods: A multicenter, pilot pharmacotherapy quality improvement program was undertaken in a long-term care facility setting. Consultant pharmacists reviewed pharmacy records and medical charts from long-term care facilities, identifying older patients with a diagnosis of hypertension who either took CCB concomitantly with an ACE inhibitor or experienced adverse events on high-dose CCB therapy. Eligible patients were identified and their physicians contacted regarding switching them to fixed-dose combination therapy. Results: A total of 51 patients at 17 facilities were switched to fixed-dose amlodipine/benazepril combination therapy; 94.1% were women and 5.9% were men (mean age, 85.1 years; range, 64–99 years). The mean number of comorbidities was 1.6. During the subsequent 2 months, mean blood pressure remained at levels similar to those at baseline. The number of patients reporting at least 1 drug-related adverse event decreased by 81.8% ( P < 0.05), and the incidence of edema decreased by 75.0%. The mean per-patient cost of antihypertensive drugs decreased by 33.1% ( P < 0.001), a mean per-patient savings of $19.21 per month. Conclusion: In patients aged ≥65 years with hypertension in long-term care facilities, a change from high-dose CCB monotherapy or CCB/ACE-inhibitor dual therapy to fixed-dose combination amlodipine/benazepril therapy significantly reduced drug costs and the incidence of adverse events and maintained blood-pressure control.