Greene Ronald S, Escobar Quinones Marissa, Edwards Krystal L
School of Pharmacy, Texas Tech University Health Sciences Center; and Veterans Affairs North Texas Health Care System. Dallas, TX ( USA ).
School of Pharmacy, Texas Tech University Health Sciences Center. Dallas, TX ( USA ).
Pharm Pract (Granada). 2007 Jul;5(3):130-4. doi: 10.4321/s1886-36552007000300006.
Thiazide diuretics are effective antihypertensive medications shown to reduce the risk of cardiovascular events and stroke. Despite being the preferred choice for uncomplicated essential hypertension, thiazide diuretics continue to be underutilized.
Uncomplicated essential hypertension patients taking a single antihypertensive medication were evaluated upon enrollment, diagnosis after enrollment or initiation of therapy in treatment naïve patients. Clinician prescribing habits were determined for both pre-existing and newly diagnosed hypertensive patients. For the cost savings analysis, hydrochlorothiazide (HCTZ) 25mg daily was selected as the preferred conversion medication.
Four hundred seventy-eight patients were included. ACE inhibitors were the most prescribed at 35.4% (n=169), followed by dihydropyridine calcium channel blockers (DHP CCB) and thiazide diuretics, both at 20.3% (n=97). Only 12.9% (n=33) of patients with hypertension that were taking an antihypertensive medication upon enrollment were either continued or started on thiazide diuretic therapy. Newly diagnosed or treatment naïve patients were prescribed a thiazide diuretic 28.8% (n=64) of the time. DHP CCB accounted for 58.8% of the total medication cost per month with thiazide diuretics responsible for 0.8% of the cost. If all patients had been prescribed HCTZ 25mg daily, 95.8% of the total medication cost per month could have been saved.
Thiazide diuretics were underutilized as preferred therapy in patients with pre-existing or newly diagnosed uncomplicated essential hypertension. While cost of therapy should not be the sole reason for medication selection, thiazide diuretics are an attractive option and should be considered as a preferred therapy in this patient population.
噻嗪类利尿剂是有效的抗高血压药物，已证明可降低心血管事件和中风的风险。尽管噻嗪类利尿剂是单纯性原发性高血压的首选药物，但仍未得到充分利用。
对服用单一抗高血压药物的单纯性原发性高血压患者在入组时、入组后诊断或初治患者开始治疗时进行评估。确定了既往高血压患者和新诊断高血压患者的临床医生处方习惯。为了进行成本节约分析，选择每日25mg氢氯噻嗪（HCTZ）作为首选的转换药物。
纳入478例患者。血管紧张素转换酶抑制剂的处方率最高，为35.4%（n = 169），其次是二氢吡啶类钙通道阻滞剂（DHP CCB）和噻嗪类利尿剂，均为20.3%（n = 97）。入组时正在服用抗高血压药物的高血压患者中，只有12.9%（n = 33）继续或开始接受噻嗪类利尿剂治疗。新诊断或初治患者接受噻嗪类利尿剂治疗的时间占28.8%（n = 64）。DHP CCB占每月总药物成本的58.8%，噻嗪类利尿剂占成本的0.8%。如果所有患者都每日服用25mg HCTZ，则每月可节省95.8%的总药物成本。
噻嗪类利尿剂作为既往或新诊断的单纯性原发性高血压患者的首选治疗方法未得到充分利用。虽然治疗成本不应是选择药物的唯一原因，但噻嗪类利尿剂是一个有吸引力的选择，应被视为该患者群体的首选治疗方法。
