Use Of Antihypertensive Drug Classes Research Articles

Abstract P116: Hypertension Treatment and Control in Canadians with Diabetes

Introduction: 3 million Canadians and 23 million Americans have concurrent hypertension and diabetes. Blood pressure (BP) control reduces the risk of heart attacks, strokes, retinopathy, and kidney disease. We investigated hypertension control rates in patients with diabetes, responses to uncontrolled BP measurements, and use of antihypertensive drug classes. Methods: We performed an observational study of adults with diabetes and hypertension drawing from the IQIVA primary care database (contains data on 1.2 million Canadians). Our first outcome was mean BP at 3, 6, 12, and 24 months after inclusion. Our second outcome was the number of uncontrolled BP measurements (≥130/80) followed by a physician BP check, medication dose/frequency increase, or new medication in the subsequent 6 weeks. Our third outcome (for a subset of individuals with medication data available) was the number of individuals prescribed renin-angiotensin-aldosterone-system inhibitors (RAASi), dihydropyridine calcium channel blockers (DHP-CCBs), or thiazide/thiazide-like diuretics. Results: We identified 10,814 individuals identified with both diabetes and hypertension. Mean BP (in mmHg) remained largely unchanged over 24 months: 136.7/78.6 at 3 months, 135.5/82.2 at 6 months, 137.2/82.8 at 12 months, and 136.6/82.3 at 24 months. Over the two years of follow-up there were 55,381 uncontrolled BP events, and in the subsequent 6 weeks only 27,877 (50.3%) were followed by ≥1 physician BP checks. Among individuals with medication data, there were 16,364 uncontrolled BP events, 33.4% followed by a new antihypertensive medication and 18.2% followed by an antihypertensive dose/frequency change. Of the 6,919 individuals for whom we had medication data, 6,216 (89.8%) were prescribed a RAASi, 2,371 (34.3%) were prescribed a DHP-CCB, and 1,672 (24.2%) were prescribed thiazide/thiazide like diuretic. Conclusion: Over two-thirds (68.8%) of people with diabetes and hypertension had uncontrolled blood pressure that persisted over 2 years during which half of uncontrolled BPs were followed by a physician BP check in 6 weeks, and one-fifth by a antihypertensive dose/frequency change. While almost 90% were treated with RAASi, over a third were on a DHP-CCB and less than one quarter were treated with a thiazide/thiazide like diuretic. Therapeutic inertia and under-prescribing of dual and triple therapy contribute to persistently high BP thus represent opportunities for improvement.

USE OF ANTIHYPERTENSIVE DRUG CLASSES DURING THE COVID-19 PANDEMIC. A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021

Objective: To assess changes in the use of antihypertensive drug classes during the COVID-19 pandemic, data of all patients who filled a prescription for an antihypertensive drug in Poland were analyzed. Design and method: Patients who filled at least one prescription from ATC groups C02-03, C07-10, C10BX in each of the years 2019, 2020 and 2021 were extracted from the obligatory prescription database of the National Health Service in Poland. We have excluded patients with a diagnosis of heart failure. The frequencies of use of antihypertensive drug classes – beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), calcium channel blockers (CCB), thiazide diuretics (TD), thiazide-like diuretics (TLD), loop diuretics (LD), mineralocorticoid receptor antagonists (MRA) and alpha-blockers (AB) - and their combinations were analyzed for the years 2019, 2020 and 2021 respectively. Results: In the years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. Among the main groups of antihypertensive drugs, the most used drug groups were BB (62.0, 62.8 and 63.7%), ACEi (52.9, 52.7 and 46.8%) and CCB (34.5, 35.2 and 35.9%). ARB were used by 26.8, 27.3 and 28.2% of patients. Diuretics were used by: TD 14.2, 13.9 and 14.1%; TLD 23.3, 22.8 and 22.6%, LD 13.0, 12.8 and 12.9%, AA 8.5%, 8.3%, 8.5%. AB were rarely used (4.5, 4.5, and 4.5%). Among patients taking two anithypertenisve drugs, the most common combination was BB+ACEi 23.5, 19.7 and 18.7%. BB+other anithypertensive drugs was used by 48.6, 46.9 and 45.7% of patients. ACEi/ARB+TD/TLD and ACEi/ARB+CCB combinations were used by 24.3, 23.4 and 23.6% and 17.4, 17.6 and 18.4% of patients, respectively. Among patients taking three drugs, BB+ACEi/ARB+TD/TLD combination was used by 29.8, 26.4, 25.7% of patients, followed by combinations: BB+ACEi/ARB+CCB 21.3, 19.8 and 19.9% and ACEi/ARB+CCB+TD/TLD 15.2, 17.2 and 18.5% of patients. Conclusions: The COVID-19 pandemic had little impact on changes in the frequency of use of individual antihypertensive drug groups. A slight increase in the use of the two and three drugs’ combinations recommended by the ESC/ESH 2018 guidelines was observed in 2021 compared to 2019.

Current use of antihypertensive drugs in Japanese patients with hypertension: Analysis by age group.

To analyze the current use of antihypertensive drug classes in Japanese hypertensive patients stratified by age, highlighting differences between older and younger patients. A nationwide medical database was used to evaluate antihypertensive use in patients (aged ≥20 years) who had received a prescription for one or more antihypertensive drug as an outpatient from April 2014 to March 2015. Patients (n = 59 867) were age-stratified into three groups: <65 years (28.7%), 65-74 years (33.1%) and ≥75 years (38.2%). The mean number of antihypertensive drugs prescribed for patients in the overall population was 1.9 ± 1.0, with no appreciable differences between age groups. The most commonly prescribed drug classes for all ages were calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB). CCB were prescribed more often than ARB in the 65-74 years (66.9% vs 60.5%) and ≥75 years (70.4% vs 56.8%) years age groups, and ARB were prescribed more often than CCB in patients aged <65 years (63.1% vs 61.9%). There were minimal differences by age in prescription rates for β-blockers, angiotensin-converting enzyme inhibitors and thiazide diuretics. ARB prescription rates were lower in patients aged ≥75 years with diabetes mellitus or renal disease than in younger age groups. Prescription rates for loop diuretics were higher in patients aged ≥75 years than in younger age groups, especially among those with renal disease. Antihypertensive drugs selected for patients aged ≥75 years differed from those selected for younger patients, in particular CCB and loop diuretics (prescribed more often), and ARB (prescribed less often). Geriatr Gerontol Int 2018; 18: 899-906.

Queen Mary Utilization of Antihypertensive Drugs Study: use of antihypertensive drug classes in the Hypertension Clinic 1996–2004

Utilization of antihypertensive drugs in the hypertension outpatient clinic is surveyed periodically in the Queen Mary Utilization of Antihypertensive Drugs Study (QUADS). Two hundred and fifty-one patients (123 men, 128 women) were interviewed in April to December 1996, 439 patients (232 men, 207 women) in January to December 99 and 228 patients (109 men, 119 women) in April to May 2004. Their case notes were reviewed. The percentages of patients receiving no drug (lifestyle modification), one, two, three and over three drugs were 7%, 48%, 36%, 7%, 3%, respectively, in 1996; 14%, 34%, 36%, 13% and 1%, respectively, in 1999; and 3%, 30%, 40%, 22% and 6%, respectively, in 2004. The number of drugs correlated with age and overweight. In 1996, 51% patients received calcium channel blockers (CCB); 46% beta-blockers (BB); 32% angiotensin-converting enzyme inhibitors (ACEI); 15% thiazide diuretics; 5% alpha-blockers; and 0% angiotensin receptor blockers (ARB). In 1999, the respective figures were 52% CCB, 49% BB, 24% ACEI, 22% thiazide diuretics, 4%alpha-blockers and 2% ARB. In 2004, the respective figures were 65% CCB, 64% BB, 33% ACEI, 24% thiazide diuretics, 4% alpha-blockers and 7% ARB. Fewer patients on BBs reported side-effects. Only 11% were on alpha statin and 9% on aspirin. Blood pressure on treatment was 147 +/- 21/84 +/- 11 mmHg in 1999 and 144 +/- 21/82 +/- 11 mmHg in 2004. Increasingly, multiple drugs were used for blood pressure control. Blood pressure control needs improvement, especially in diabetics. CCBs and BBs were consistently popular. Thiazide diuretics, ARBs, statins and aspirin were underused, despite favourable clinical trial evidence.

Relación entre el perfil de riesgo cardiovascular y la selección y utilización de los fármacos antihipertensivos

Hypertension guidelines emphasize the selection of antihypertensive treatment on the basis of absolute cardiovascular risk. Moreover, compelling and possible indications for each antihypertensive drug class are recommended for patients with other concomitant conditions. The aim of the present study was to analyze the relationship between the cardiovascular risk profile and co-morbid conditions on antihypertensive drug class use. This is an observational, multicenter, cross-sectional study performed in 2,850 essential hypertensive patients. Antihypertensive drug treatment has been evaluated on the basis of the presence of other cardiovascular risk factors, target organ damage or cardiovascular diseases, as well as the absolute cardiovascular risk profile. Patients with diabetes were treated more frequently with calcium channel blockers (CCB) and ACE inhibitors. However, the presence of hypercholesterolemia or smoking habit did not influence the use of antihypertensive drug classes. The presence of cerebrovascular disease increased the use of CCB and ACE inhibitors, whereas coronary disease increased the use of CCB and betablockers. The use of diuretics and angiotensin II receptor antagonists was increased in patients with cardiac failure, whereas neither betablockers nor ACE inhibitors were affected by this concomitant disease. Patients with the highest cardiovascular risk received more antihypertensive treatment than those with lower risk, but this was not accompanied by switching from old classes to new ones. Cardiovascular risk profile seems to have little influence on the use of antihypertensive drug classes, particularly the presence of hypercholesterolemia or cardiac failure. It seems adequate to emphasize the necessity of an individualization of antihypertensive treatment, based on the presence of concomitant conditions that influence the absolute cardiovascular risk.