Initial Antihypertensive Prescription and Switching: A 5 Year Cohort Study from 250,851 Patients

Abstract

PurposeAdverse effects of antihypertensive therapy incur substantial cost. We evaluated whether any major classes of antihypertensive drugs were significantly associated with switching as a proxy measure of medication side effects in a large Chinese population in Hong Kong.MethodsFrom a clinical database, all adult patients newly prescribed an antihypertensive mono-therapy in Hong Kong between the years 2001–2003 and 2005 were included. Those who paid only one visit, died or stayed in the cohort for <180 days after the prescription, or prescribed more than one antihypertensive agent were excluded. The factors associated with switching at 180 days were evaluated by multivariate regression analyses. Age, gender, payment status, service type, district of residence, drug class, systolic and diastolic blood pressure levels were predictor variables.ResultsFrom 250,851 subjects, 159,813 patients were eligible. A total of 6,163 (3.9%) switched their medications within 180 days. Patients prescribed thiazide diuretics had the highest switching rate (5.6%), followed by ACEIs (4.5%), CCBs (4.4%) and beta-blockers (3.2%). When compared with ACEIs, patients on thiazide diuretics were significantly more likely to be switchers (adjusted odds ratio [AOR] 1.49, 95% C.I. 1.31–1.69, p<0.001), whilst patients prescribed CCBs and beta-blockers were similarly likely to have switching. Following these patients up for 5 years showed that thiazide had the most marked increase in switching rate.ConclusionsThe higher rates of switching among thiazide diuretics in this study might raise a probably greater incidence of their adverse effects in this Chinese population, yet other factors might also influence switching rates. Patients prescribed thiazide diuretics for longer term should be observed for their intolerability.

Tolerability of Antihypertensive Medications in Older Adults

“…No psychosocial stressor variables associated with nonadherence Greater depressive symptoms noted to be an association Although alcohol misuse was an association, it was not a mediator between depression and nonadherence [167] Veterans study, propensity score-matched cohort of 18 Assignment of the code prior to treatment was associated with higher all-cause mortality in incident hypertensives, but did not worsen adherence to drugs [168] Antihypertensive medication adherence and mortality, based on ethnicity Province-wide antihypertensive drug data base (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) Polypills reduced BP and lipids vs. PL Tolerability was lower with polypills than PL, but differences were moderate [176] Initial antihypertensive prescription and switching 5-year cohort study, 250,851 Chinese pts in Hong Kong, 159,813 eligible 6163 (3.9 %) switched their medication within 180 days Highest switch rate for thiazides, followed by ACEIs, CCBs, and b-blockers AEs were likely basis, suggesting the need to observe for tolerability [182] Tolerability of Antihypertensive Medications Table 4 continued Study characteristics…”

Change of Hypertension Treatment Scheme in Outpatient Care at Specialized Cardiologic Institution, and Factors Associated With the Change of Antihypertension Therapy

“…В сходном британском исследовании 20,2% паци-ентов прекратили лечение в течение 6 месяцев после назначения терапии [7], а в крупном китайском исследовании в течение аналогичного периода вре-мени после назначения АГТ только 3,9% пациентов изменили схему лечения (все варианты, включая пол-ный отказ от терапии) [8].…”

“…Частота изменений схемы лечения, рекомендо-ванной врачом, варьирует в различных исследова-ниях, и, если в европейских странах это показатель достаточно высок (например, в Италии через полгода после назначения лечения кумулятивная частота пре-кращения и замены препаратов составляют 33% и 15%, соответственно [6]), то среди китайских паци-ентов с АГ изменение АГТ не превышает 5% в тече-ние 6 месяцев [8]. Высокая частота изменений схемы лечения приводит не только к снижению эффектив-ности терапии, но и к нерациональному использова-нию ограниченных ресурсов системы здравоохране-ния [10].…”

“…В то же время в исследовании Degli Esposti E., отсутствие изменений терапии пациентов с АГ ассоциировалось с возрастом (пропорционально увеличению лет жизни) и полом (сохранение терапии чаще у мужчин) [13], противоположные ассоциации с возрастом и гендерным фактором продемонстрированы в китай-ском исследовании [8].…”

“…У этих пациентов, как правило, сложная многокомпонентная схема лечения, что повышает вероятность отказа от отдельных препаратов, осо-бенно если пациент не понимает цели их применения и того, какого эффекта следует от них ожидать. Ассо-циация наличия коморбидных заболеваний с увели-чением вероятности изменения схемы лечения пока-зана в ранее проведенных исследованиях [8].…”