BackgroundRecent studies on the prescribing of hormonal replacement therapy (HRT) medicines to treat symptoms of menopause are lacking.AimTo describe the prescribing of HRT in a cohort of UK menopausal women.Design & settingPopulation-based drug utilization study using IQVIA Medical Research Database.MethodPrimary care data of women with recorded menopause and/or 50 years and older between January 2010 and November 2021 were extracted from the database. The incidence rate (IR) of women who received their first prescription for HRT was calculated annually using person-years at risk (PYAR) as the denominator. IRs of HRT were estimated by type and route of administration. Relative changes in annual IR were expressed as percentages and the average percentage change was assessed using linear regression. Annual prescribing prevalence per 100 women was calculated using mid-year menopausal population estimates.ResultsThe IR of prescribing of HRT increased from 5.01 in 2010–18.16 per 1000 PYAR in 2021, a relative increase of 13.64% (95% CI 6.97–20.30) per year. IR of fixed combinations of HRT increased from 3.33 to 12.23 per 1000 PYAR in 2010 and 2021, respectively. Transdermal formulations of HRT increased from 1.48 to 14.55 per 1000 PYAR in 2010 and 2021, respectively. The overall proportion of women in receipt of a prescription for HRT changed from 7.89% in 2010 to 6.8% in 2020.ConclusionOur study shows steady increase in the number of women receiving their first prescription for HRT during the study period which suggests regained acceptance of HRT medicines.
INTRODUCTIONWe investigated trends in the incidence of dementia in UK adults with hypertension.METHODSPrimary care electronic health records from IQVIA Medical Research Data UK, previously known as THIN, were used to identify 2,133,118 adults aged ≥40 years with hypertension over 2000 to 2021. The annual incidence rate and average annual percentage change in recorded dementia diagnoses were estimated and stratified by sex, 10‐year age bands, Townsend deprivation quintiles and dementia subtype.RESULTSThe crude incidence rate of dementia in people with hypertension increased from 1.98 (95% confidence internal [CI] 1.89–2.07) per 1000 person‐years at risk (PYAR) in 2000 to 5.29 per 1000 PYAR (95% CI 5.07–5.53) in 2021, corresponding to an average annual increase of 4.1% (95% CI 3.3–5.0). Those aged ≥80 years, the most economically deprived (Townsend = 5), and Alzheimer's disease subtype reported the highest incidence rate within their respective categories.DISCUSSIONThe annual incidence rate of dementia in the hypertensive population has increased over the last 22 years.Highlights New dementia diagnosis in the hypertensive population has increased over 22 years. The Alzheimer's disease subtype reported the highest incidence rate in people with hypertension. Difference in dementia incidence between hypertensive females and males has reduced. Difference in dementia incidence among deprivation categories has reduced in recent years.
Background: Adverse drug reactions (ADRs)related to angiotensin-converting enzyme inhibitor(ACEI) and angiotensin receptor blocker(ARB) may negatively affect patients’ treatment outcomes. There is limited evidence on the impact of ADRs on patients’ outcome in real-world clinical setting. Aim: To investigate the impact of ACEI/ARB-related ADRs consultations in primary care on patients’ clinical outcomes. Design: Propensity score-matched cohort study of ACEI/ARB users during 2004-2019 using IQVIA medical research data. Methods: ACEI/ARB-related ADRs consultations were identified using standardised designated codes in primary care medical records data.Propensity scores were calculated based on comorbidities,concomitant medications,frailty index,polypharmacy,and interval between ACEI/ARB initiation and ADRs date.The outcomes of interest were cardiovascular disease (CVD) events and all-cause mortality.Cox proportional hazard regression models were used to compare the outcomes between ADRs and non-ADRs group. Results: Among 1,471,906 eligible ACEI/ARB users,13,652 patients(0.93%) had ACEI/ARB-related ADRs consultation in primary care. Mean follow-up duration were6.57and4.84years for the CVD primary(n=6,196) and secondary(n=14,238) prevention cohorts,respectively. ACEI/ARB-related ADRs were associated with CVD events and all-cause mortality in both primary(adjusted HR.1.22,95%CI1.05,1.43 and 1.14,95%CI1.01,1.27) and secondary prevention cohort (adjusted HR.1.13,95%CI1.05,1.21 and 1.15,95%CI1.09,1.21).Half (50.19%) patients with ADRs consultation continued to use ACEI/ARB and these patients had a reduced risk of mortality(adjusted HR.0.88,95%CI0.82,0.95) compared to those who discontinued ACEI/ARB. Conclusions: This study provides information on the burden of ADRs on patients and the health system. Patients with ACEI/ARB-related ADRs consultation had an increased risk of subsequent CVD events and mortality,indicating additional monitoring and treatment strategies by healthcare professionals for affected patients are needed to mitigate the risks of adverse clinical outcomes.
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