Antihypertensive Therapy
Antihypertensive Therapy
Purpose: The patterns of angiotensin II-receptor blocker (ARB) therapy in patients with and without a history of antihypertensive use were studied.
Methods: Data for this retrospective cohort study were obtained from Caremark's data warehouse. Patients were included in the analysis if they filled prescriptions for ARBs only, did not receive ARB therapy within the 6 months before the filling of the first ARB prescription (index date), were continuously eligible for benefits for 6 months before the index date, were eligible for prescription benefits for the 12 months following the index date, and were age 2080 years.
Results: Of the 174,573 patients sampled, 53.4% were new to all antihypertensive therapies. Of the patients receiving an ARB, 67.9% received another antihypertensive during the evaluation period. Over 40% of patients new to all antihypertensive therapies had no other antihypertensive added to their ARB regimen. Of the patients with a history of antihypertensive use, 22.3% discontinued all antihypertensives before starting therapy with an ARB. Patients starting therapy with losartan and valsartan were less likely to be treated with mono-therapy and more likely to be treated with ARBdiuretic therapy than were patients starting therapy with telmisartan, irbesartan, or candesartan.
Conclusion: Patients who started antihypertensive therapy with ARBs tended to be new to antihypertensive therapy and, in a plurality of cases, continued to receive therapy with ARBs only. More than a fifth of patients who received antihypertensive therapy in the recent past were switched from that therapy to treatment with ARBs only. Treatment patterns differed by initial ARB used and the demographic profile of the patient.
Six different classes of drugs are frequently used for the treatment of hypertension: angiotensin-converting-enzyme (ACE) inhibitors, ß-blockers, calcium channel blockers (CCBs), diuretics, α-blockers, and, the newest class, angiotensin II-receptor blockers (ARBs). ARBs were developed to block the actions of angiotensin II and provide an improved adverse-effect profile over that of ACE inhibitors. In addition to hypertension, the six classes of antihypertensives have been approved for the treatment of a variety of other indications. A wealth of clinical information on the effectiveness of each class is available. However, limited information is available regarding how patients actually use these drugs. Adherence to antihypertensive therapy has received some attention in the literature; however, the rates of concomitant use of these medications have not.
"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC7) distinguishes two stages of hypertension requiring medication, each with and without comorbid conditions. The report's authors recommend pharmacotherapy for (1) uncomplicated stage 1 hypertension, (2) stage 2 hypertension without comorbid conditions, and (3) hypertension with comorbid conditions. The authors recommend treating most patients who have stage 1 uncomplicated hypertension with thiazide-type diuretics. Treatment with ACE inhibitors, ARBs, ß-blockers, or CCBs may also be an option for these patients. Patients with stage 2 hypertension (≥160 mm Hg systolic or ≥100 mm Hg diastolic blood pressure) should receive treatment with a diuretic and another antihypertensive. Similarly, patients with comorbid conditions could be treated with a combination of antihypertensives, depending on the nature of the comorbid conditions. The authors also recommend the addition of another antihypertensive drug rather than stopping one antihypertensive and starting another unless the drug is contraindicated or not tolerable. It is estimated that most patients treated for hypertension will require combination therapy to reach their goal blood pressure.
The JNC7 has provided physicians with guidelines for future prescribing behavior. Data on the real-world prescribing patterns and on patient adherence to these guidelines will help clinicians and researchers evaluate how closely physicians and patients adhere to these guidelines and provide a baseline for measuring future changes. If physicians and patients follow the JNC7 guidelines, specific patterns of medication use should emerge.
The purpose of this study was to examine the patterns of treatment with ARBs in patients with and without a history of antihypertensive use. The effects of physician specialty, patient demographics, and initial brand choice of an ARB on subsequent patterns of use were also studied.
An analysis of drug-use patterns from a sample of all patients receiving antihypertensives is beyond the scope of one study. Therefore, we limited our analysis to patients initiating antihypertensive therapy with ARBs.
Because our goal was to analyze treatment patterns with ARBs and other medications used for hypertension rather than investigate the reasons behind specific use patterns of drugs, we chose to analyze treatment patterns using a large pharmaceutical claims dataset. To keep the focus on patterns of drug use, comorbid conditions were not addressed. Our goal was not to speculate about the reasons for a change in therapy but rather elaborate on the patterns of drug use observed.
Purpose: The patterns of angiotensin II-receptor blocker (ARB) therapy in patients with and without a history of antihypertensive use were studied.
Methods: Data for this retrospective cohort study were obtained from Caremark's data warehouse. Patients were included in the analysis if they filled prescriptions for ARBs only, did not receive ARB therapy within the 6 months before the filling of the first ARB prescription (index date), were continuously eligible for benefits for 6 months before the index date, were eligible for prescription benefits for the 12 months following the index date, and were age 2080 years.
Results: Of the 174,573 patients sampled, 53.4% were new to all antihypertensive therapies. Of the patients receiving an ARB, 67.9% received another antihypertensive during the evaluation period. Over 40% of patients new to all antihypertensive therapies had no other antihypertensive added to their ARB regimen. Of the patients with a history of antihypertensive use, 22.3% discontinued all antihypertensives before starting therapy with an ARB. Patients starting therapy with losartan and valsartan were less likely to be treated with mono-therapy and more likely to be treated with ARBdiuretic therapy than were patients starting therapy with telmisartan, irbesartan, or candesartan.
Conclusion: Patients who started antihypertensive therapy with ARBs tended to be new to antihypertensive therapy and, in a plurality of cases, continued to receive therapy with ARBs only. More than a fifth of patients who received antihypertensive therapy in the recent past were switched from that therapy to treatment with ARBs only. Treatment patterns differed by initial ARB used and the demographic profile of the patient.
Six different classes of drugs are frequently used for the treatment of hypertension: angiotensin-converting-enzyme (ACE) inhibitors, ß-blockers, calcium channel blockers (CCBs), diuretics, α-blockers, and, the newest class, angiotensin II-receptor blockers (ARBs). ARBs were developed to block the actions of angiotensin II and provide an improved adverse-effect profile over that of ACE inhibitors. In addition to hypertension, the six classes of antihypertensives have been approved for the treatment of a variety of other indications. A wealth of clinical information on the effectiveness of each class is available. However, limited information is available regarding how patients actually use these drugs. Adherence to antihypertensive therapy has received some attention in the literature; however, the rates of concomitant use of these medications have not.
"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC7) distinguishes two stages of hypertension requiring medication, each with and without comorbid conditions. The report's authors recommend pharmacotherapy for (1) uncomplicated stage 1 hypertension, (2) stage 2 hypertension without comorbid conditions, and (3) hypertension with comorbid conditions. The authors recommend treating most patients who have stage 1 uncomplicated hypertension with thiazide-type diuretics. Treatment with ACE inhibitors, ARBs, ß-blockers, or CCBs may also be an option for these patients. Patients with stage 2 hypertension (≥160 mm Hg systolic or ≥100 mm Hg diastolic blood pressure) should receive treatment with a diuretic and another antihypertensive. Similarly, patients with comorbid conditions could be treated with a combination of antihypertensives, depending on the nature of the comorbid conditions. The authors also recommend the addition of another antihypertensive drug rather than stopping one antihypertensive and starting another unless the drug is contraindicated or not tolerable. It is estimated that most patients treated for hypertension will require combination therapy to reach their goal blood pressure.
The JNC7 has provided physicians with guidelines for future prescribing behavior. Data on the real-world prescribing patterns and on patient adherence to these guidelines will help clinicians and researchers evaluate how closely physicians and patients adhere to these guidelines and provide a baseline for measuring future changes. If physicians and patients follow the JNC7 guidelines, specific patterns of medication use should emerge.
The purpose of this study was to examine the patterns of treatment with ARBs in patients with and without a history of antihypertensive use. The effects of physician specialty, patient demographics, and initial brand choice of an ARB on subsequent patterns of use were also studied.
An analysis of drug-use patterns from a sample of all patients receiving antihypertensives is beyond the scope of one study. Therefore, we limited our analysis to patients initiating antihypertensive therapy with ARBs.
Because our goal was to analyze treatment patterns with ARBs and other medications used for hypertension rather than investigate the reasons behind specific use patterns of drugs, we chose to analyze treatment patterns using a large pharmaceutical claims dataset. To keep the focus on patterns of drug use, comorbid conditions were not addressed. Our goal was not to speculate about the reasons for a change in therapy but rather elaborate on the patterns of drug use observed.
