Antihypertensive drug treatment changes in the general population: the colaus study

Abstract

BackgroundChanges in antihypertensive drug treatment are paramount in the adequate management of patients with hypertension, still, there is little information regarding changes in antihypertensive drug treatment in Switzerland. Our aim was to assess those changes and associated factors in a population-based, prospective study.MethodsData from the population-based, CoLaus study, conducted among subjects initially aged 35–75 years and living in Lausanne, Switzerland. 772 hypertensive subjects (371 women) were followed for a median of 5.4 years. Data Subjects were defined as continuers (no change), switchers (one antihypertensive class replaced by another), combiners (one antihypertensive class added) and discontinuers (stopped treatment). The distribution and the factors associated with changes in antihypertensive drug treatment were assessed.ResultsDuring the study period, the prescription of diuretics decreased and of ARBs increased: at baseline, diuretics were taken by 46.9% of patients; angiotensin receptor blockers (ARB) by 44.7%, angiotensin converting enzyme inhibitors (ACEI) by 28.8%, beta-blockers (BB) by 28.0%, calcium channel blockers (CCB) by 18.9% and other antihypertensive drugs by 0.3%. At follow-up (approximately 5 years later), their corresponding percentages were 42.8%, 51.7%, 25.5%, 33.0% 20.7% and 1.0%. Among all participants, 54.4% (95% confidence interval: 50.8-58.0) were continuers, 26.9% (23.8-30.2) combiners, 12.7% (10.4-15.3) switchers and 6.0% (4.4-7.9) discontinuers. Combiners had higher systolic blood pressure values at baseline than the other groups (p < 0.05). Almost one third (30.6%) of switchers and 29.3% of combiners improved their blood pressure status at follow-up, versus 18.8% of continuers and 8.7% of discontinuers (p < 0.001). Conversely, almost one third (28.3%) of discontinuers became hypertensive (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), vs. 22.1% of continuers, 16.3% of switchers and 11.5% of combiners (p < 0.001). Multivariate analysis showed baseline uncontrolled hypertension, ARBs, drug regimen (monotherapy/polytherapy) and overweight/obesity to be associated with changes in antihypertensive therapy.ConclusionIn Switzerland, ARBs have replaced diuretics as the most commonly prescribed antihypertensive drug. Uncontrolled hypertension, ARBs, drug regimen (monotherapy or polytherapy) and overweight/obesity are associated with changes in antihypertensive treatment.

Ramipril + amlodipine and ramipril + hydrochlorothiazide fixed-dose combinations in relation to patient adherence

“… 15 An analysis of Swiss prescription data indicated a decrease in diuretic sales and an increase in calcium channel blocker sales over a 5-year period. 16 Treatment adherence was significantly better with ramipril +amlodipine than ramipril + hydrochlorothiazide in the present study, in accordance with evidence supporting advantages of ACEI + calcium channel blocker combinations. 17 …”

First Line CombinAtion Therapy in the Treatment of Stage II and III Hypertension (FLASH)

“…The FLASH study involving 780 patients investigated the efficacy and safety of a single-pill combination BP-lowering therapy including HCTZ and irbesartan in subjects with moderate or severe hypertension, one third previously untreated and two thirds in whom prior therapy had not been sufficient to reach the target BP. The clinical profile of the study participants was balanced and in line with the patient characteristics from the CoLaus study, and it may thus be considered representative of the Swiss population of patients with hypertension (21,22).…”

Would Anti-Hypertensive Treatment be a Risk Factor for National Health Budget of Turkey in 2023?

“…Because of these variables, the prices of group C09CA, C09DA and C09DB drugs are higher than those of group C09AA, C09BA and C09BB drugs. While group C09AA, C09BA and C09BB drugs are preferred more frequently for the treatment of hypertension, group C09CA, C09DA and C09DB groups are prescribed less frequently [15]. The increase in the consumption of group C09BA, C09BB, C09DA, C09DB drugs during the study period implies that the production of combined anti-hypertensive drugs as well as their preparation and prescription in threemonth-long packages has become more favorable in Turkey after 2005.…”