Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.
Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.
Am J Hypertens. 2022 Jul 1;35(7):601-609. doi: 10.1093/ajh/hpac013.
Drug-related adverse events associated with antihypertensive therapy may result in subsequent prescribing of other potentially harmful medications, known as prescribing cascades. The aim of this study was to assess the magnitude and characteristics of a beta-blocker-edema-loop diuretic prescribing cascade.
A prescription sequence symmetry analysis was used to assess loop diuretic initiation before and after initiation of beta-blockers among patients 20 years or older without heart failure, atrial fibrillation, other arrythmias, or use of calcium channel blocker within a U.S. private insurance claims database (2005-2018). The temporality of loop diuretic initiation relative to a beta-blocker or negative control (renin-angiotensin system blocker) initiation was tabulated. Secular trend-adjusted sequence ratios (aSRs) with 95% confidence intervals (CIs) compared the initiation of loop diuretic 90 days before and after initiation of beta-blockers.
Among 988,675 beta-blocker initiators, 9,489 patients initiated a new loop diuretic prescription 90 days after and 5,245 patients before beta-blocker initiation, resulting in an aSR of 1.78 (95% CI, 1.72-1.84). An estimated 1.72 beta-blocker initiators per 100 patient-years experienced the prescribing cascade in the first 90 days. The aSR was disproportionately higher among older adults (aSR 1.97), men (aSR 2.25), and patients who initiated metoprolol tartrate (aSR 2.48), labetalol (aSR 2.18), or metoprolol succinate (aSR 2.11). Negative control results (aSR 1.09, 95% CI, 1.05-1.13) generally corroborated our findings, but suggested modest within-person time-varying confounding.
We observed excess use of loop diuretics following beta-blocker initiation that was only partially explained by secular trends or hypertension progression.
与降压治疗相关的药物不良反应可能导致随后开处方其他潜在有害药物，这被称为处方级联。本研究的目的是评估β受体阻滞剂-噻嗪类利尿剂处方级联的严重程度和特征。
在美国私人保险理赔数据库（2005-2018 年）中，使用处方序列对称性分析评估了 20 岁或以上无心力衰竭、心房颤动、其他心律失常或使用钙通道阻滞剂的患者中β受体阻滞剂起始前后噻嗪类利尿剂的起始情况。记录噻嗪类利尿剂起始相对于β受体阻滞剂或阴性对照（肾素-血管紧张素系统阻滞剂）起始的时间顺序。95%置信区间（CI）的时间调整序列比（aSR）比较了β受体阻滞剂起始前 90 天和后 90 天噻嗪类利尿剂的起始情况。
在 988675 例β受体阻滞剂起始者中，有 9489 例患者在β受体阻滞剂起始后 90 天内开始新的噻嗪类利尿剂处方，有 5245 例患者在β受体阻滞剂起始前开始，aSR 为 1.78（95%CI，1.72-1.84）。估计每 100 患者年有 1.72 例β受体阻滞剂起始者发生了该处方级联。在年龄较大的成年人（aSR 1.97）、男性（aSR 2.25）和起始酒石酸美托洛尔（aSR 2.48）、拉贝洛尔（aSR 2.18）或琥珀酸美托洛尔（aSR 2.11）的患者中，aSR 不成比例地更高。阴性对照结果（aSR 1.09，95%CI，1.05-1.13）通常证实了我们的发现，但表明存在轻微的个体内时间变化混杂。
我们观察到在β受体阻滞剂起始后噻嗪类利尿剂的使用增加，这部分是由时间趋势或高血压进展解释的。
