Context It is still debated whether prolonged use of proton pump inhibitors (PPIs) might affect metabolic health. Objective To investigate the relationship between prolonged use of PPIs and the risk of developing diabetes. Methods We performed a case-control study nested into a cohort of 777,420 patients newly treated with PPIs between 2010 and 2015 in Lombardy, Italy. A total of 50,535 cases diagnosed with diabetes until 2020 were matched with an equal number of controls that were randomly selected from the cohort members according to age, sex, and clinical status. Exposure to treatment with PPIs was assessed in case-control pairs based on time of therapy. A conditional logistic regression model was fitted to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the exposure-outcome association, after adjusting for several covariates. Sensitivity analyses were performed to evaluate the robustness of our findings. Results Compared to patients who used PPIs for <8 weeks, higher odds of diabetes of 19% (95% CI, 15–24%), 43% (38–49%), and 56% (49–64%) were observed among those who used PPIs for between 8 weeks and 6 months, 6 months and 2 years, and >2 years, respectively. The results were consistent when analyses were stratified according to age, sex and clinical profile, with higher ORs being found in younger patients and those with worse clinical complexity. Sensitivity analyses revealed that the association was consistent and robust. Conclusions Regular and prolonged use of PPIs is associated with a higher risk of diabetes. Physicians should therefore avoid unnecessary prescription of this class of drugs, particularly for long-term use.

Objective: Randomized controlled trials have shown that renal denervation lowers office and ambulatory blood pressure. However, the clinical environment of controlled trials is different from that characterizing medical practice, making real-life data appropriate to provide information on a number of issues, e.g. whether renal denervation is followed by a change in the intensity and type of antihypertensive drug use. The aim of the present study was to evaluate whether patients undergoing renal denervation procedure in a real-life setting have a reduction in antihypertensive drug prescription over the subsequent years. Design and method: Using the healthcare utilization database of the Lombardy Region (Italy), the 136 patients who, during the period 2011–2016, were prescribed four or more antihypertensive drugs and underwent renal denervation were included in the study cohort. The number and type of antihypertensive drugs were assessed over the year before and during the three-year period after renal denervation. Hospitalizations for cardiovascular diseases were also assessed during the three years before and during the three years after renal denervation. Results: The median age of the patients was 67 years and 68% of them were men. Based on a multisource comorbidity score, about 40% of patients showed a poor or very poor clinical status. Before renal denervation, about 80% of the patients were prescribed four or five antihypertensive drugs. The number of drugs decreased after the denervation: after three years, patients prescribed 4/5 drugs were 57% and patients prescribed six drugs decreased from 18% to 2%. Reduced prescription extended to all antihypertensive drugs throughout the post-denervation period. Compared to the year before the denervation, after three years prescription of diuretics was reduced by 15%, calcium channel blockers by 21%, angiotensin-converting enzyme inhibitors by 32%, angiotensin receptor blockers by 22%, beta-blockers by 20%, alfa-blockers by 30%, and mineralocorticoid receptor antagonists by 30%. Hospitalizations for cardiovascular diseases did not show appreciable differences between the two periods (before and after the renal denervation). Conclusions: In the real-life setting, patients who underwent renal denervation had a clearcut reduction in antihypertensive drug prescription over the following years.

Objective: To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique.Results: 28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two

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Objective: To compare adherence to antihypertensive treatment between patients prescribed the perindopril/amlodipine/indapamide single-pill combination (SPC) vs the combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic (D) as a SPC of two drugs plus the third drug separately. Design and method: Patients aged > = 40 years who received a prescription of perindopril/amlodipine/indapamide SPC during 2015-2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a subject who started ACEI/CCB/D treatment as a two-drug SPC plus a third drug separately (i.e. 2 pills) at the index date was identified. Adherence to the triple combination was assessed over the year after the index date as the proportion of the follow-up days covered (PDC) by prescription. The primary aim was to compare the odds of being highly adherent to the drug therapy (PDC>75%) between groups. Secondary aims were to compare (i) the risk of cardiovascular hospitalizations and (ii) the costs of cardiovascular health services (hospitalizations, drugs, and outpatient services). Log-binomial regression models were fitted to estimate the risk ratio, and its 95% confidence interval, of treatment adherence in relation to the drug strategy. A Cox model and a linear regression model were fitted to compare the risk of cardiovascular hospitalizations and mean of healthcare costs, respectively, between groups. Results: 28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two pills. Compared with patients under two-pill combination, those who were treated with the SPC had a higher propensity to be highly adherent to the triple combination (2.38, 2.32 – 2.44). Three-drug SPC users had a 13% lower risk of cardiovascular hospitalizations and a € 64 lower costs for cardiovascular healthcare services (p < 0.001) due to reduced hospitalization costs (€ 59). Conclusions: In a real-life setting, patients who were prescribed the perindopril/amlodipine/indapamide SPC exhibited more frequently a good adherence to antihypertensive treatment than those prescribed a combination of ACEI/CCB/D as a two drugs SPC plus a third drug separately.