Current prescription status of antihypertensive drugs in Japanese patients with hypertension: Analysis by type of comorbidities

Abstract

In 2014, the Japanese Society of Hypertension (JSH) issued revised guidelines for hypertension management. To assess adherence to the guidelines, this retrospective study evaluated the real-world status of antihypertensive drug prescribing for Japanese patients with hypertension, classified by comorbidity: diabetes mellitus, dyslipidemia, gout/hyperuricemia and renal diseases. Data on 59,867 hypertensive patients who received their first prescription for antihypertensive therapy between April 2014 and March 2015, were obtained from a medical insurance claims database for hospitals participating in the Diagnosis Procedure Combination/Per-Diem payment system. The most common drugs prescribed for each comorbidity subgroup were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs), with prescription rates of around 60-70%. Contrary to JSH recommendations, diuretics and angiotensin-converting enzyme inhibitors were prescribed less often than β-blockers. Whereas diabetes mellitus is a compelling indication for use of renin-angiotensin system inhibitors, CCBs were commonly prescribed in this subgroup. The treatment pattern for patients with comorbid dyslipidemia closely resembled that for the overall patient population. Loop diuretics were prescribed more frequently for patients with renal diseases or gout/hyperuricemia than for those with diabetes mellitus or dyslipidemia. Although antihypertensive drug prescribing varied by comorbidity, JSH 2014 guidelines appeared not to be incorporated adequately into actual clinical practice.

Treatment patterns of antihypertensive fixed‐dose combinations according to age and number of agents prescribed: Retrospective analysis using a Japanese claims database

“…The present analyses show that the real‐world use of FDC varies depending on the desired combination and number of agents prescribed. Overall, the majority of patients in the present study were prescribed one or two antihypertensive agents, and the most frequently prescribed classes of agents were CCB and ARB, consistent with similar analyses carried out in Japan using pharmacy prescription data . We found that the prescription rate of CCB + ARB FDC was relatively low overall, and did not increase depending on the total number of antihypertensive agents prescribed.…”

“…The most common comorbidities were dyslipidemia (56.8%) and heart diseases (52.0%; Table ). Overall, 58.6% of patients were prescribed two or more antihypertensive agents, and the most frequently prescribed classes of agent were CCB and ARB with rates of approximately 35% …”

“…When a CCB + an ARB were prescribed as part of a three‐agent combination, the CCB + ARB FDC was used in 22.0% of patients in combination with a β‐blocker, and in 11.0% in combination with a thiazide diuretic. In our previous analysis, of all patients who received three‐agent combinations, approximately 50% received a CCB + an ARB + a β‐blocker or a CCB + an ARB + a thiazide diuretic . However, in the current study, the ARB + diuretic FDC was used in 60.7% of patients when prescribed in the three‐agent combination with CCB (Fig.…”

“…Detailed methods of the present retrospective analysis have been reported in full previously . Briefly, we analyzed data from the Medical Data Vision (MDV; Tokyo, Japan) database for patients who were entered into the system with hypertension and who were dispensed an antihypertensive agent prescription within the target selection period of April 2014 to March 2015.…”

“…Data were analyzed by IQVIA Solutions Japan K.K. (Tokyo, Japan) and stored in standalone (not connected to a local area network) personal computers that could be locked with a password …”