Hypertension management in diabetic patients: prescribing trends from 1999 to 2005 in three Japanese university hospitals

Kamijima, Yukari; Ooba, Nobuhiro; Yagame, Mitsunori; Samizo, Kazuo; Shimodozono, Yoshihiro; Kageyama, Shigeru; Horiguchi, Shingo; Nagai, Ryozo; Kusunoki, Tomoichi; Kubota, Kiyoshi

doi:10.1002/pds.1609

Cited by 9 publications

(5 citation statements)

References 43 publications

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“…We were unable to identify any previous studies that evaluated antihypertensive prescribing rates across a patient population classified by comorbidity type, although two studies assessed drugs prescribed to the specific subpopulation of hypertensive patients with diabetes mellitus (19,20). Whereas diabetes mellitus is a compelling indication for use of RAS inhibitors (2), we found that CCBs are still commonly prescribed in this subgroup.…”

Section: Discussionmentioning

confidence: 89%

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

Ishida

Hiroi

et al. 2018

Clinical and Experimental Hypertension

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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.

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Section: Discussionmentioning

confidence: 89%

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

Ishida

Hiroi

et al. 2018

Clinical and Experimental Hypertension

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“…Reflecting the clinical evidence, including the findings of the ACCOMPLISH study [4], an angiotensin-receptor blocker (ARB) together with a calcium-channel blocker (CCB) is the combination most frequently prescribed to Japanese hypertensive patients [5,6]. For patients who have comorbidities such as hyperlipidemia, diabetes, and chronic renal disease, more aggressive treatment, with the addition of thiazide diuretics (i.e., hydrochlorothiazide or HCTZ) is provided to achieve therapeutic goals [7].…”

Section: Introductionmentioning

confidence: 99%

Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis

Akazawa

Fukuoka²

2013

BMC Health Serv Res

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BackgroundThe prescription of fixed-dose combinations (FDC) of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction.In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs.MethodsClaims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers (ARBs). Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC (control group). Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers’ characteristics.ResultsThere were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers’ characteristics. The switch to FDC was associated with an annual saving of 10,420 yen (US$112.0) in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen (US$25.5).ConclusionsFor hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs.

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“…Similarly, in Japan, CCBs are the most common followed by RAAS inhibitors (usually ARBs), while diuretics are commonly used in elderly patients [ 113 , 114 , 117 , 121 , 133 ]. The high use of CCBs in Japan was demonstrated in an analysis of pharmacies dispensing in Kitakyushu City (10,585 antihypertensive prescriptions) [ 113 ], a review of prescriptions dispensed at three Tokyo hospitals ( n = 27,033 without diabetes and n = 4604 with diabetes) [ 117 ] and two nationwide medical insurance claims analyses (one n = 59,867 [ 114 , 133 ] and the other n = 1,863,298 [ 121 ]).…”

Section: Resultsmentioning

confidence: 99%

Management of Hypertension in the Asia-Pacific Region: A Structured Review

Rahman,

Magno,

Cai

et al. 2024

Am J Cardiovasc Drugs

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This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin–angiotensin–aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-023-00625-1.

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Hypertension management in diabetic patients: prescribing trends from 1999 to 2005 in three Japanese university hospitals

Cited by 9 publications

References 43 publications

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

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

Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis

Management of Hypertension in the Asia-Pacific Region: A Structured Review

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