Adherence to Available Clinical Practice Guidelines for Initiation of Antihypertensive Medication in Patients With or Without Diabetes Mellitus and Other Comorbidities in Taiwan

Abstract

The aim of the study is to explore the prescribing trends for antihypertensive medications in newly diagnosed hypertensive subjects with different comorbidities with or without diabetes in Taiwan. Factors for prescribing angiotensin receptor blockers (ARBs) are also investigated. The study design is a secondary data analysis of Taiwanese population from the National Health Insurance, from 1997, to 2004. A total of 3 218 187 patients were included in the statistical analysis; there were 2 963 861 cases without diabetes and 254 326 with diabetes. From 1998 to 2004, in both arms, there were significant trends for increasing ARB use (ρ = 0.964, P < .001). Patients with preexisting diabetes were more likely to be prescribed ARBs than those without preexisting diabetes (OR = 1.68; 95% CI, 1.65-1.70). A similar situation was noted for patients with the comorbidities of cerebrovascular accident (OR = 1.61), congestive heart failure (OR = 2.20), coronary artery disease (OR = 1.63), and chronic kidney disease (OR = 2.23). Although diuretics were not the most commonly prescribed antihypertensive for nondiabetics during the study period, physicians' prescribing practices were within the range of published clinical practice guidelines for hypertension management. Further comprehensive studies are needed to explore the impact of prescription patterns, especially ARBs, on the allocation of health care resources and therapeutic efficacy in Taiwan.

Angiotension receptor blockers reduce the risk of dementia

“…Most of them (89.0%) received ARBs after stroke, but ARBs were prescribed in 3718 patients (31.3%) before stroke. In Taiwan, prescription ARBs are commonly used in patients who have had cerebrovascular accidents [34]. The incidence of dementia in patients who received ARBs after stroke was significantly lower than in the group exposed to ARBs before stroke (71.5 vs. 123.5 per 10 4 person-years).…”

“…Renin-angiotensin system inhibitors are the drugs of choice for patients with hypertension and other comorbidities, such as diabetes and coronary heart disease [32,33]. In Taiwan, diabetes patients with cerebrovascular accidents, congestive heart failure, coronary heart disease or chronic kidney disease are more likely to be prescribed ARBs than those without comorbidities [34]. In our study, unmatched comorbid diseases (stroke, heart failure and chronic kidney disease) were higher in the ARB group, and ARBs still showed significant protective effects against dementia, vascular dementia and Alzheimer's disease.…”