Family and Community Medicine Unit, Casto Prieto Health Centre, Salamanca, Spain.
Drugs Aging. 2009;26(7):617-26. doi: 10.2165/11316370-000000000-00000.
Diuretics are considered to be agents of first choice when treating hypertension in the elderly because of their clinical efficacy and, in particular, their low cost. Indeed, the latter consideration has been used by health resource managers to promote the use of diuretics. However, when considering the costs of treating hypertension in a population it is also necessary to assess the adverse effects that diuretics produce, particularly in elderly people.
To compare the overall expenditure associated with the treatment of hypertension (specifically the angiotensin II type 1 receptor antagonist eprosartan vs diuretics) in an elderly population, taking into consideration not only the drug acquisition costs but also the adverse effects of treatment and the costs associated with such adverse effects.
This was a prospective, observational, nonrandomized, open-label, multicentre study based in eight community health centres and the Hypertension Unit of the University Hospital of Salamanca, Spain. The study included 220 hypertensive geriatric outpatients (males and females aged >or=65 years) referred from general practitioners and the Hypertension Unit, with a mean age of 71.8 years and distributed into two groups: one (n = 90) treated with diuretics and the other (n = 130) treated with eprosartan. Following an initial clinical assessment of patients at the beginning of the study, monitoring of treatment continued for 1 year with follow-up consultations scheduled for 3, 6 and 12 months. Both the costs relating to acquisition of the drugs and the costs derived from secondary adverse effects of drug treatment were included in the analysis.
The response to the antihypertensive therapy was similar in both groups. In patients taking diuretics, adverse events resulted in increased use of healthcare resources because of urinary incontinence, purchase of adsorbents, hyponatraemia and the need to admit two patients to hospital. The patient/day cost was euro 1.05 for the group treated with diuretics and euro 0.98 for the group treated with eprosartan (year of costing 2006).
In the geriatric population, the acquisition cost of the prescribed diuretics is not representative of the actual antihypertensive treatment expenditure. According to the results obtained in our study, the overall costs of eprosartan therapy were no different to those of diuretics, despite the fact that eprosartan had a higher acquisition cost. This is consistent with a more favourable safety profile for eprosartan, which may possibly contribute to improved prescription compliance. This conclusion should be taken into consideration when evaluating economic restrictions on the use of drugs.
由于临床疗效确切，特别是价格低廉，利尿剂被认为是治疗老年人高血压的首选药物。事实上，卫生资源管理者正是利用了后者这一考虑因素来促进利尿剂的使用。然而，在考虑人群高血压治疗成本时，还必须评估利尿剂产生的不良反应，尤其是在老年人中。
比较老年人群中治疗高血压（特别是血管紧张素 II 型 1 型受体拮抗剂依普罗沙坦与利尿剂）的总体支出，不仅要考虑药物获得成本，还要考虑治疗的不良反应以及与这些不良反应相关的成本。
这是一项前瞻性、观察性、非随机、开放性、多中心研究，在西班牙萨拉曼卡大学医院的 8 个社区卫生中心和高血压科进行。该研究纳入了 220 名高血压老年门诊患者（年龄>或=65 岁的男性和女性），由全科医生和高血压科转诊，平均年龄 71.8 岁，分为两组：一组（n = 90）接受利尿剂治疗，另一组（n = 130）接受依普罗沙坦治疗。在研究开始时对患者进行初始临床评估后，继续监测治疗 1 年，随访时间为 3、6 和 12 个月。分析中包括与药物获得相关的成本以及药物治疗继发性不良反应产生的成本。
两组患者对降压治疗的反应相似。在使用利尿剂的患者中，由于尿失禁、购买吸附剂、低钠血症和需要住院治疗 2 名患者，药物治疗的不良反应导致医疗资源使用增加。接受利尿剂治疗的患者每人每天的费用为 1.05 欧元，接受依普罗沙坦治疗的患者每人每天的费用为 0.98 欧元（2006 年计价）。
在老年人群中，处方利尿剂的获得成本不能代表实际的降压治疗支出。根据我们的研究结果，尽管依普罗沙坦的获得成本较高，但依普罗沙坦治疗的总费用与利尿剂治疗无差异。这与依普罗沙坦具有更有利的安全性特征一致，这可能有助于提高处方的依从性。在评估药物使用的经济限制时，应考虑这一结论。
