Clinical Pharmacologist, Pretoria, South Africa.
Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
Adv Ther. 2023 Nov;40(11):5076-5089. doi: 10.1007/s12325-023-02641-8. Epub 2023 Sep 21.
Differences in class or molecule-specific effects between renin-angiotensin-aldosterone system (RAAS) inhibitors have not been conclusively demonstrated. This study used South African data to assess clinical and cost outcomes of antihypertensive therapy with the three most common RAAS inhibitors: perindopril, losartan and enalapril.
Using a large, South African private health insurance claims database, we identified patients with a hypertension diagnosis in January 2015 receiving standard doses of perindopril, enalapril or losartan, alone or in combination with other agents. From claims over the subsequent 5 years, we calculated the risk-adjusted rate of the composite primary outcome of myocardial infarction, ischaemic heart disease, heart failure or stroke; rate of all-cause mortality; and costs per life per month (PLPM), with adjustments based on demographic characteristics, healthcare plan and comorbidity.
Overall, 32,857 individuals received perindopril, 16,693 losartan and 13,939 enalapril. Perindopril-based regimens were associated with a significantly lower primary outcome rate (205 per 1000 patients over 5 years) versus losartan (221; P < 0.0001) or enalapril (223; P < 0.0001). The risk-adjusted all-cause mortality rate was lower with perindopril than enalapril (100 vs. 139 deaths per 1000 patients over 5 years; P = 0.007), but not losartan (100 vs. 94; P = 0.650). Mean (95% confidence interval) overall risk-adjusted cost PLPM was Rands (ZAR) 1342 (87-8973) for perindopril, ZAR 1466 (104-9365) for losartan (P = 0.0044) and ZAR 1540 (77-10,546) for enalapril (P = 0.0003).
In South African individuals with private health insurance, a perindopril-based antihypertensive regimen provided better clinical and cost outcomes compared with other regimens.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂的类别或分子特异性作用的差异尚未得到明确证实。本研究使用南非数据评估了三种最常见的 RAAS 抑制剂（培哚普利、氯沙坦和依那普利）的降压治疗的临床和成本结果。
我们使用南非大型私人医疗保险索赔数据库，确定了 2015 年 1 月接受标准剂量培哚普利、依那普利或氯沙坦单独或与其他药物联合治疗的高血压诊断患者。在随后的 5 年内，我们根据人口统计学特征、医疗保健计划和合并症，计算了复合主要结局（心肌梗死、缺血性心脏病、心力衰竭或中风）的风险调整发生率、全因死亡率以及每个生命每月的成本（PLPM）。
共有 32857 人接受了培哚普利治疗，16693 人接受了氯沙坦治疗，13939 人接受了依那普利治疗。与氯沙坦（221；P < 0.0001）或依那普利（223；P < 0.0001）相比，培哚普利方案的主要结局发生率显著较低（5 年内每 1000 例患者 205 例）。与依那普利相比，培哚普利的全因死亡率风险调整较低（5 年内每 1000 例患者 100 例与 139 例死亡；P = 0.007），但与氯沙坦相比则无差异（100 例与 94 例；P = 0.650）。总体风险调整后每个生命每月的平均（95%置信区间）成本为培哚普利 Rands（ZAR）1342（87-8973），氯沙坦 ZAR 1466（104-9365）（P = 0.0044），依那普利 ZAR 1540（77-10,546）（P = 0.0003）。
在南非有私人医疗保险的个体中，与其他方案相比，基于培哚普利的降压方案提供了更好的临床和成本结果。
