British Heart Foundation Centre, King's College London, London, UK.
Br J Clin Pharmacol. 2019 Dec;85(12):2707-2713. doi: 10.1111/bcp.14109. Epub 2019 Dec 9.
Thiazide diuretics have been the cornerstone of hypertension treatment for >5 decades. Most recent European and American guidelines recommend both thiazide-type and thiazide-like diuretics as first-line drugs for all patients with hypertension. In contrast, diuretics are not regarded as first-line treatment in the UK and in patients who are to be initiated on a diuretic treatment, thiazide-like molecules, such as chlortalidone and indapamide are the preferred option. This review examines the prescribing trend of the 4 most commonly prescribed thiazide diuretics for the treatment of hypertension in the UK. Prescription cost analysis data were obtained for both 2010 and 2016/2017 for each region of the UK to analyse the impact of the 2011 National Institute for Health and Care Excellence hypertension guidelines on the trend in thiazide diuretic prescribing. Overall, the prescriptions of thiazide diuretics declined over the years. Bendroflumethiazide is the most commonly prescribed diuretic in the UK and despite some geographical differences, thiazide-type diuretics are more widely used than thiazide-like. The use of indapamide increased significantly between 2010 and 2016/2017 while chlortalidone was rarely employed. Of the many factors affecting trends in prescriptions, clinical inertia, treatment adherence, availability of the products and the lack of fixed dose combinations may play a role.
噻嗪类利尿剂作为高血压治疗的基石已超过 50 年。最近的欧美指南均推荐噻嗪类和噻嗪样利尿剂作为所有高血压患者的一线治疗药物。相比之下，在英国利尿剂并不作为一线治疗药物，在开始使用利尿剂治疗的患者中，噻嗪样药物，如氯噻酮和吲达帕胺，是首选。本文回顾了英国最常开的 4 种噻嗪类利尿剂治疗高血压的处方趋势。本文获取了英国各地区 2010 年和 2016/2017 年的处方费用分析数据，以分析 2011 年国家卫生与保健卓越研究所高血压指南对噻嗪类利尿剂处方趋势的影响。总体而言，噻嗪类利尿剂的处方量逐年下降。尽管存在一些地域差异，但在英国，苄氟噻嗪是最常开的利尿剂，噻嗪型利尿剂的使用比噻嗪样利尿剂更为广泛。吲达帕胺的使用在 2010 年至 2016/2017 年间显著增加，而氯噻酮则很少使用。在影响处方趋势的诸多因素中，临床惰性、治疗依从性、药物的可获得性以及缺乏固定剂量复方制剂可能发挥了作用。
