Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan.
Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Xueshi Rd., Taichung, Taiwan.
Sci Rep. 2024 Mar 28;14(1):7402. doi: 10.1038/s41598-024-58153-0.
Prescribing cascade is a significant clinical problem but is often overlooked. We explore the incidence of the prescribing cascades of antigout medications related to thiazide treatment in gout-naïve hypertensive adults newly exposed to the pharmacological treatment. This population-based, retrospective cohort study used the Taiwan National Health Insurance Registry Database. Gout-naïve hypertensive adults who were newly dispensed first-line antihypertensive drugs between January 1, 2000, and December 31, 2016, were enrolled. Patients were divided into the thiazide group (n = 4192) and the non-thiazide group (n = 81,083). The non-thiazide group included patients who received an angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-blocker. The study utilized propensity score matching and multivariable Cox regression models to investigate the prescribing cascade of antigout agents following antihypertensive treatment, adjusting for factors like age, sex, comorbidities, and concurrent medications. After propensity score matching, each group consisted of 4045 patients, with the thiazide group exhibiting a higher risk of being prescribed antigout medications across different time intervals post-treatment initiation. Specifically, adjusted hazard ratios (aHRs) for the thiazide group were 2.23, 2.07, and 2.41 for < 30 days, 31-180 days, and > 180 days, respectively, indicating a sustained and significant risk over time. Comparative analyses revealed thiazide diuretics were associated with a higher risk of antigout medication prescriptions compared to other antihypertensive classes, particularly evident after 180 days. Subgroup analyses across various demographics and comorbidities consistently showed an increased risk in the thiazide cohort. Gout-naïve hypertensive adults newly dispensed thiazide had a higher risk of subsequently adding antigout agents than those taking other first-line antihypertensive medications. The awareness and interruption of these prescribing cascades are critical to improving patient safety.
处方传递是一个重要的临床问题，但经常被忽视。我们探讨了在新接受药物治疗的痛风初发高血压成年人中，噻嗪类药物相关降尿酸药物处方传递的发生率。这项基于人群的回顾性队列研究使用了台湾全民健康保险登记数据库。2000 年 1 月 1 日至 2016 年 12 月 31 日期间，新开出一线降压药物的痛风初发高血压成年人被纳入研究。患者分为噻嗪组（n=4192）和非噻嗪组（n=81083）。非噻嗪组包括接受血管紧张素转换酶抑制剂、血管紧张素 II 受体阻滞剂、钙通道阻滞剂或β受体阻滞剂的患者。研究采用倾向评分匹配和多变量 Cox 回归模型，在调整年龄、性别、合并症和同时使用的药物等因素后，调查降压治疗后降尿酸药物的处方传递情况。在倾向评分匹配后，每组各有 4045 例患者，噻嗪组在治疗开始后不同时间间隔内开具降尿酸药物的风险更高。具体而言，噻嗪组的调整后危险比（aHR）分别为治疗开始后<30 天、31-180 天和>180 天的 2.23、2.07 和 2.41，表明随着时间的推移风险持续且显著增加。与其他降压药物相比，噻嗪类利尿剂与降尿酸药物处方之间的相关性更高，特别是在 180 天后更为明显。各种人群特征和合并症的亚组分析均显示噻嗪组的风险增加。与其他一线降压药物相比，新开出噻嗪类药物的痛风初发高血压成年人随后添加降尿酸药物的风险更高。这些处方传递的意识和干预对于提高患者安全性至关重要。
