Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.
BMJ Open. 2022 Jun 10;12(6):e057510. doi: 10.1136/bmjopen-2021-057510.
To describe the prescribing trends of antihypertensive drugs in primary care patients and assess the trajectory of antihypertensive drug prescriptions, from first-line to third-line, in patients with hypertension according to changes to the United Kingdom (UK) hypertension management guidelines.
Population-based cohort study.
We used the UK Clinical Practice Research Datalink, an electronic primary care database representative of the UK population. Between 1988 and 2018, we identified all adult patients with at least one prescription for a thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, beta-blocker or calcium channel blocker (CCB).
We estimated the period prevalence of patients with antihypertensive drug prescriptions for each calendar year over a 31-year period. Treatment trajectory was assessed by identifying patients with hypertension newly initiating an antihypertensive drug, and treatment changes were defined by a switch or add-on of a new class. This cohort was stratified before and after 2007, the year following important changes to UK hypertension management guidelines.
The cohort included 2 709 241 patients. The prevalence of primary care patients with antihypertensive drug prescriptions increased from 7.8% (1988) to 21.9% (2018) and was observed for all major classes except thiazide diuretics. Patients with hypertension initiated thiazide diuretics (36.8%) and beta-blockers (23.6%) as first-line drugs before 2007, and ACE inhibitors (39.9%) and CCBs (31.8%) after 2007. After 2007, 17.3% were not prescribed guideline-recommended first-line agents. Overall, patients were prescribed a median of 2 classes (IQR 1-2) after first-line treatment.
Nearly one-quarter of primary care patients were prescribed antihypertensive drugs by the end of the study period. Most patients with hypertension initiated guideline-recommended first-line agents. Not all patients, particularly females, were prescribed recommended agents however, potentially leading to suboptimal cardiovascular outcomes. Future research should aim to better understand the implication of this finding.
描述初级保健患者中抗高血压药物的处方趋势，并根据英国（UK）高血压管理指南的变化，评估高血压患者从一线到三线抗高血压药物处方的轨迹。
基于人群的队列研究。
我们使用了英国临床实践研究数据链接，这是一个代表英国人口的电子初级保健数据库。在 1988 年至 2018 年期间，我们确定了所有至少有一次噻嗪类利尿剂、血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂或钙通道阻滞剂（CCB）处方的成年患者。
我们估计了 31 年来每个日历年度接受抗高血压药物治疗的患者的期间患病率。通过确定新开始抗高血压药物治疗的高血压患者来评估治疗轨迹，并通过添加或更换新类别来定义治疗变化。该队列在 2007 年（英国高血压管理指南发生重大变化后的一年）前后进行了分层。
该队列包括 2709241 名患者。初级保健患者中接受抗高血压药物治疗的患者比例从 1988 年的 7.8%增加到 2018 年的 21.9%，所有主要类别均观察到这一趋势，除噻嗪类利尿剂外。2007 年前，高血压患者开始使用噻嗪类利尿剂（36.8%）和β受体阻滞剂（23.6%）作为一线药物，2007 年后则使用 ACE 抑制剂（39.9%）和 CCBs（31.8%）。2007 年后，17.3%的患者未开出处方推荐的一线药物。总体而言，患者在一线治疗后平均服用 2 种药物（IQR 1-2）。
研究结束时，近四分之一的初级保健患者接受了抗高血压药物治疗。大多数高血压患者开始使用指南推荐的一线药物。然而，并非所有患者，特别是女性，都开出处方推荐的药物，这可能导致心血管结局不理想。未来的研究应旨在更好地了解这一发现的意义。
