ALLHAT 研究结果对意大利艾米利亚-罗马涅大区抗高血压药物处方模式的影响。

Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA.

J Clin Pharm Ther. 2010 Feb;35(1):55-61. doi: 10.1111/j.1365-2710.2009.01047.x.

BACKGROUND AND OBJECTIVE

Studies from the US and Canada observed changes in antihypertensive prescribing patterns in accordance with Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study findings immediately after the study's publication, but little is known about the impact of ALLHAT in Italy. The objective of this study was to examine antihypertensive prescribing patterns in Regione Emilia-Romagna (RER), Italy, following the publication of the ALLHAT main results.

METHODS

We conducted a time series analysis using automated pharmacy data of approximately 4 million RER residents between 1 January 2000 and 31 December 2003. We computed monthly relative percentages of prescriptions for all antihypertensive medications and separately for all new antihypertensives defined as no recorded antihypertensive use in the previous year. A stepwise auto-regressive forecasting model based on data prior to the ALLHAT publication was used to estimate predicted relative percentages for the 12 months following the ALLHAT publication. Observed and predicted values were compared.

RESULTS AND DISCUSSION

Use of thiazide-type diuretics showed a general increasing trend over the study period, but the difference between the observed and predicted values reached statistical significance only for new prescriptions in October 2003 (3.71% vs. 2.32%; P = 0.0170). The relative percentage of new angiotensin-converting enzyme inhibitor and angiotensin receptor blocker (ACE/ARB) prescriptions was higher than predicted for the months May to August 2003 (P < 0.05), but no significant differences were observed for total ACE/ARB prescriptions. Modest changes in patterns of prescribing of calcium channel blockers and alpha-blockers were observed.

CONCLUSION

We found little evidence that the ALLHAT study had an impact on antihypertensive prescribing patterns in RER in the year following their publication.

背景与目的

美国和加拿大的研究观察到，在 ALLHAT 研究结果公布后，抗高血压药物的处方模式发生了变化，但关于 ALLHAT 在意大利的影响知之甚少。本研究的目的是在 ALLHAT 主要结果公布后，检查意大利艾米利亚-罗马涅地区（RER）的抗高血压药物处方模式。

方法

我们使用大约 400 万 RER 居民在 2000 年 1 月 1 日至 2003 年 12 月 31 日期间的自动药房数据进行了时间序列分析。我们计算了所有抗高血压药物和所有新的抗高血压药物（定义为前一年无记录的抗高血压药物使用）的每月相对百分比。使用基于 ALLHAT 发布前数据的逐步自回归预测模型，估计 ALLHAT 发布后 12 个月的预测相对百分比。比较观察值和预测值。

结果与讨论

噻嗪类利尿剂的使用在研究期间呈总体上升趋势，但仅在 2003 年 10 月新处方中观察到的和预测的差异达到统计学意义（3.71%比 2.32%；P = 0.0170）。2003 年 5 月至 8 月，新的血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂（ACE/ARB）处方的相对百分比高于预测值（P < 0.05），但总 ACE/ARB 处方无显著差异。钙通道阻滞剂和α-阻滞剂的处方模式略有变化。