scholarly journals Consumption of single products versus fixed-dose combination medicines for hypertension and hyperlipidemia during 2015–2019 in South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259467
Author(s):  
Yujin Lee ◽  
Jihye Shin ◽  
Yujeong Kim ◽  
Dong-Sook Kim
Keyword(s):  
Older Adults ◽  
South Korea ◽  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
Fixed Dose ◽  
Channel Blockers ◽  
Defined Daily Dose ◽  
Annual Growth Rate ◽  
Angiotensin Ii Receptor ◽  
Reductase Inhibitors

Background Fixed-dose combinations can simplify prescribing, and numerous combination products exist for hypertension and dyslipidemia in South Korea. This study’s aim was to compare trends in the consumption of single products versus fixed-dose combinations for hypertension and hyperlipidemia. Methods and findings We analyzed the Korean national health insurance claims database from January 2015 through December 2019. Consumption of medicines was calculated using the defined daily dose per 1,000 inhabitants per day (DIDs) and expenditures over time. During 2015–2019, the use of antihypertensive drugs increased with an annual growth rate (AGR) of 0.9% for single products and with an AGR of 35.6% for fixed-dose combinations. A notable increase was observed for antihyperlipidemic combination drugs with an AGR of 268.1% compared to single products with 35.7%. For older adults (65+ years), the consumption of drugs for hypertension and hyperlipidemia was 3–4.5 and about 3 times higher, respectively, than in adults aged 20–64 years, and a sharp increase was found in antihyperlipidemic fixed-dose combinations among older adults. A large increase was seen for C09 (agents acting on the renin-angiotensin system) with an AGR of 36.5%, especially C09DB (angiotensin II receptor blockers + calcium channel blockers) was widely used and steeply increased with 114.2%. For antihyperlipidemic drugs, C10AA (HMG CoA reductase inhibitors) accounted for a large share and sharply increased, with 52.1 DIDs in 2019 and with an AGR of 78.4%, whereas C10BA (combinations of various lipid modifying agents) increased 9.6 times from 2.9 DIDs (96 million USD) in 2015 to 27.7 DIDs (912 million USD) in 2019. Conclusion The findings of increased consumption and drug spending among older adults underscores the need for real-world evidence about health outcomes of fixed-dose combinations in this population.

Abstract 512: Drugs in the Elderly: Threats and Opportunities

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Martin Wehling
Keyword(s):  
Elderly People ◽  
Antihypertensive Drugs ◽  
Rank Order ◽  
Renin Angiotensin System ◽  
The Elderly ◽  
The United States ◽  
Channel Blockers ◽  
Aged Population ◽  
Type D ◽  
Long Acting

Taking 10 and more drugs is unpredictable and may cause more harm than good, given that up to 100,000 medication-related deaths in the United States annually. An early attempt to improve drug safety in the aged population was the establishment of criteria for drugs to avoid by Beers in 1997. The evidence for the effectiveness of the Beers list is not compelling.. There should also be a positive labelling of drugs that are indispensable in elderly people as data on morbidity, mortality, and safety are available or emerging for this particular group. There is increasing clinical evidence for beneficial action of, for example, antihypertensive drugs (e.g., Hypertension in the Very Elderly Trial) in elderly people. Drugs should be labelled taking into consideration their usefulness for elderly people (Table 1) This classification would be an extension of the Beers approach into the positive listing of valuable drugs. This seems necessary as overtreatment and undertreatment are both typical problems of the aged population. Undertreatment, for example, relates to the poor control of arterial hypertension elderly people and may leave more than half of the patients un- or undertreated. The FORTA classification for antihypertensive drugs as an example is as follows: diuretics B, betablockers B, renin-angiotensin-system blockers A, long acting dihydropyridine calcium channel blockers (CCB) A, CCBs, verapamil type D, spironolactone C, alphablockers C, clonidine D, minoxidil D. The typical use of the scheme would address general practitioners struggling with polypharmacy. They would then synthesize the recommendations into a rank order of drugs that they could use to cut the list short.

Hypertension

2019 ◽  
pp. 3-32
Author(s):  
Robert Zweiker ◽  
Sabine Perl
Keyword(s):  
Health Care Providers ◽  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
The Elderly ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Choice Of Treatment ◽  
Risk Treatment ◽  
Hereditary Nature

Hypertension has a major impact on cardiovascular and overall morbidity and mortality of patients. In most cases, the condition is caused by polygenetic predisposition and environmental lifestyle factors. General practitioners and other health-care providers should seek to screen for high blood pressure (BP) in all adults. Public knowledge about the disease can also help to detect previously unknown hypertension. First-degree family members of hypertensive patients deserve special attention because of the hereditary nature of the disease. Most measurements are made as in-office BP readings (>140/>90mmHg), which should be confirmed by out-of-office BP measurements in order to uncover white-coat effects. The basis for treatment decisions is ideally a calculation of the overall cardiovascular risk. Treatment of hypertension consists of both non-pharmacological lifestyle changes and pharmacological therapy. Several classes of antihypertensive drugs are available. The choice of medication is mainly dependent on compelling indications, as their main effect is BP lowering per se. From a hypertensiologist’s view, renin–angiotensin system inhibition seems an appropriate first choice of treatment for younger patients, whereas the elderly benefit more from calcium channel blockers and diuretics. Nevertheless, therapy based on the combination of 2–3 drugs is preferable in most cases.

P4561Patients adherence with fixed dose combinations of renin-angiotensin-aldosterone system inhibitors in hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G A Simonyi ◽  
T Ferenci ◽  
E Finta ◽  
S Balogh ◽  
M Medvegy
Keyword(s):  
Renin Angiotensin System ◽  
Fixed Dose ◽  
Channel Blockers ◽  
Hypertensive Patients ◽  
Renin Angiotensin ◽  
Pharmacy Claims ◽  
Persistence Rate ◽  
Significant Difference ◽  
One Year ◽  
Ras Inhibitors

Abstract Introduction The latest ESC/ESH guidelines recommended fixed dose combinations (FDC) for first therapy in hypertension. Preferred two-drug combinations are a RAS (renin–angiotensin system) blocker with a CCBs (calcium channel blockers) or a diuretic. There are no available data about these FDCs adherence in hypertension. Aim To assess one year persistence of recommended FDCs (RAS-inhibitors/CCBs or diuretics) in hypertensive patients. Method Prescriptions database of National Health Insurance Found in Hungary on pharmacy-claims were analysed between October 1, 2012 and September 30, 2013. We identified patients who filled prescriptions for FDCs of RAS-inhibitors/CCBs or diuretics prescribed for the first time in hypertensive patients who have not received similar drugs during one year before. To model the persistence, the apparatus of survival analysis was used, where “survival” was the time to abandon the medication. Results 443,149 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinuation (reference was ACEi/indapamide FDC) in patients with ACEi/CCB FDCs (n=124,154) was 44,95% (HR=0.69, [CI: 0.68–0.69], p<0.0001), ARB/HCT FDCs (n=109,707) was 42,52% (HR=0.80, [CI: 0.81–0.83], p<0.0001), ACEi/indapamide FDC (n=127,757) was 37,27% (HR=1.00, reference), ARB/CCB FDCs (n=13,542) was 29.04% (HR=1.19, [CI: 1.17–1.22], p<0.0001) and ACEi/HCT FDCs (n=67,989) was 27.47% (HR=1.17, [CI: 1.15–1.18], p<0.0001). One year peristence of FDCs Conclusions We have found significant difference between FDC s of RAS-inhibitors in hypertensive in relation of patients adherence. Our result demonstrated that ACEi/CCBs FDC therapy has the best one year persistence rate.

scholarly journals Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Seongman Bae ◽  
Ju Hyeon Kim ◽  
Ye-Jee Kim ◽  
Joon Seo Lim ◽  
Sung-Cheol Yun ◽  
...  
Keyword(s):  
Propensity Score ◽  
South Korea ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Diagnostic Code ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Risk Of Death

Abstract Background There is growing concern about the potential harmful effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). The aim of this study was to evaluate the association between recent exposure to ACEIs/ARBs and in-hospital mortality in patients with COVID-19. Methods We used data from a nationwide cohort of patients with COVID-19 from the health insurance claims data of South Korea, which were released for research purposes for public health by the Ministry of Health and Welfare of South Korea. Patients with COVID-19 were identified using the relevant diagnostic code. Propensity score matching (1:1) was carried out among patients with CVD according to the type of medication (ACEIs/ARBs vs other), and the risk of death was assessed. Results A total of 4936 patients with COVID-19 were analyzed, of whom 1048 (21.2%) had CVD. Of the 1048 patients with CVD, 864 (82.4%) received at least 1 antihypertensive medication before the diagnosis of COVID-19, including 359 (41.6%) who received ACEIs/ARBs and 505 (58.4%) who received drugs other than ACEIs/ARBs. Using the propensity scores for ACEI/ARB use, we matched 305 pairs of patients receiving ACEIs/ARBs and patients receiving other drugs. Recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality in unadjusted analysis (odds ratio [OR], 0.62; 95% CI, 0.33–1.14) or propensity score matching analysis (OR, 1.00; 95% CI, 0.46–2.16). Conclusions In patients with COVID-19 and underlying CVDs, the recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality. These findings do not support stopping or modifying ACEIs/ARBs in patients during the current COVID-19 pandemic.

scholarly journals The choice of antihypertensive therapy in correction of cognitive impairments and prevention of dementia: possibilities of valsartan and fixed-dose combination of valsartan and hydrochlorothiazide

2016 ◽  
Vol 13 (4) ◽  
pp. 47-55
Author(s):  
O D Ostroumova ◽  
I A Garelik ◽  
E A Karavashkina
Keyword(s):  
Cognitive Function ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Cognitive Impairments ◽  
Cerebral Protection ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Angiotensin Ii Receptor ◽  
Receptor Blockers ◽  
Dose Combination

This article discusses the definition, classification and pathogenetic mechanisms of cognitive functions in arterial hypertension. The authors discuss the capabilities of the different classes of antihypertensive drugs in correction of cognitive impairments and prevention of dementia. The authors also discuss the advantages of the angiotensin II receptor blockers in prevention of dementia and in their potential mechanisms of cerebral protection. The article describes in detail the possibilities of valsartan in correction of cognitive impairments associated with arterial hypertension, the advantages of valsartan in comparison with calcium antagonists and its unique neuroprotective mechanisms. We show our own results of the study concerning fixed-dose combination of valsartan and hydrochlorothiazide, and find out that this combination has high antihypertensive and cerebral protection (capacity to improve cognitive function) and effectiveness.

scholarly journals Primary stroke prevention and hypertension treatment: which is the first-line strategy?

2011 ◽  
Vol 3 (2) ◽  
pp. 12 ◽  
Author(s):  
Roberta Ravenni ◽  
Joe Jabre ◽  
Edoardo Casiglia ◽  
Alberto Mazza
Keyword(s):  
Stroke Prevention ◽  
Enzyme Inhibitors ◽  
Antihypertensive Agents ◽  
Clinical Intervention ◽  
Vascular Risk Factor ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Fixed Dose ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors

Hypertension (HT) iis considered the main classic vascular risk factor for stroke and the importance of lowering blood pressure (BP) is well established. However, not all the benefit of antihypertensive treatment is due to BP reduction <em>per se</em>, as the effect of reducing the risk of stroke differs among classes of antihypertensive agents. Extensive evidences support that angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), dihydropyridine calcium channel blockers (CCB) and thiazide diuretics each reduced risk of stroke compared with placebo or no treatment. Therefore, when combination therapy is required, a combination of these antihypertensive classes represents a logical approach. Despite the efficacy of antihypertensive therapy a large proportion of the population, still has undiagnosed or inadequately treated HT, and remain at high risk of stroke. In primary stroke prevention current guidelines recommend a systolic/diastolic BP goal of &lt;140/&lt;90 mmHg in the general population and &lt;130/80 mmHg in diabetics and in subjects with high cardiovascular risk and renal disease. The recent release in the market of the fixed-dose combination (FDC) of ACEI or ARB and CCB should provide a better control of BP. However to confirm the efficacy of the FDC in primary stroke prevention, clinical intervention trials are needed.

Trends and pattern of the utilization of cardiovascular medicines in Lithuania in 2003–2012

2014 ◽  
Vol 21 (3) ◽  
pp. 143-150
Author(s):  
Ingrida Lisauskienė ◽  
Kristina Garuolienė ◽  
Jolanta Gulbinovič
Keyword(s):  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Insurance Fund ◽  
Channel Blockers ◽  
Prescribing Pattern ◽  
Converting Enzyme Inhibitors ◽  
Mortality And Morbidity ◽  
High Consumption ◽  
Lipid Modifying Agents

Background. Despite the wide use of cardiovascular (CV) drugs, CV diseases are still the leading cause of mortality and morbidity. Analysis of drug utilization gives a possibility to evaluate effectiveness of interventions. Materials and methods. The aim of the study was to evaluate CV medicines consumption in Lithuania in 2003–2012. Data was retrieved from the SVEIDRA database of the National Health Insurance Fund. Utilization of the following groups of CVM (ATC group C) was analyzed: C02 – antihypertensive drugs, C03 – diuretics, C07 – beta blocking agents (BBs), C08 – calcium channel blockers (CCBs), C09 – agents acting on the renin–angiotensin system, C10 – lipid modifying agents. ATC/DDD methodology was used. Data was expressed as a number of DDD per 1  000 inhabitants per day (DDD/TID). Results. Consumption of CVM went from 134.5 DDD/TID in 2003 to 352.2 in 2012. Angiotensin converting enzyme inhibitors (ACEI) were the most consumed ones (66–114.8 DDD/TID), followed by CCBs (19.4–38.8 DDD/TID) and BBs (12.5–52.6 DDD/TID).There was high consumption of antihypertensives (4.7–23.9 DDD) and low consumption of diuretics (9.4–16.9 DDD/TID) and lipid modyfing agents (0.4–7.4 DDD/TID). Increasing utilization was noticed in the angiotensin II antagonist (ARBs) group (42 DDD/TID), ACEI combinations (38.6 DDD/TID) and ARBs combinations (12.9 DDD/TID) in 2012. Conclusions. Utilization of CV medicines increased in Lithuania in 2003–2012. ACEI held the first position. An extremely low utilization of lipid modifying agents, diuretics and high consumption of alpha-receptor blockers showed the need of actions on changing the prescribing pattern of CV drugs.

scholarly journals Antihypertensive Drugs and Risk of Cancer: Between Scylla and Charybdis

2020 ◽  
Author(s):  
Elias Sanidas ◽  
Maria Velliou ◽  
Dimitrios Papadopoulos ◽  
Anastasia Fotsali ◽  
Dimitrios Iliopoulos ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Current Data ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Carcinogenic Potential ◽  
Risk Of Cancer

Abstract Antihypertensive drugs namely angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta blockers, and diuretics are among the most clearly documented regimens worldwide with an overall cardioprotective benefit. Given that malignancy is the second leading cause of mortality, numerous observational studies aimed to investigate the carcinogenic potential of these agents with conflicting results. The purpose of this review was to summarize current data in an effort to explore rare side effects and new mechanisms linking antihypertensive drugs with the risk of developing cancer.

scholarly journals Rates of delirium associated with calcium channel blockers compared to diuretics, renin-angiotensin system agents and beta-blockers: An electronic health records network study

2020 ◽  
Vol 34 (8) ◽  
pp. 848-855 ◽  
Author(s):  
Paul J Harrison ◽  
Sierra Luciano ◽  
Lucy Colbourne
Keyword(s):  
Calcium Channel ◽  
Antihypertensive Drug ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Renin Angiotensin System ◽  
Negative Control ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin

Background: Antihypertensive drugs, especially calcium channel blockers, have been associated with differential rates of a number of neuropsychiatric outcomes. Delirium is commonly attributed to medication, including antihypertensive drugs, but delirium incidence has not been compared directly between antihypertensive drug classes. Methods: Using a federated electronic health records network of 25.5 million people aged 50 years or older, we measured rates of delirium over a two-year period in patients prescribed calcium channel blockers compared to the other main antihypertensive drug classes. Extensive propensity score matching was used to create cohorts matched for a range of demographic factors and delirium risk factors. Negative control outcomes were also measured. Results: Cohort sizes ranged from 54,000–577,000. Delirium was more common with calcium channel blockers than with renin-angiotensin system agents (~40% higher) but less common than with beta-blockers (~20% lower). These differences remained when patients with a range of other delirium risk factors were excluded, and they were not paralleled by the negative control outcomes. Comparisons between calcium channel blockers and diuretics produced inconclusive results. Conclusions: Calcium channel blockers are associated with higher rates of delirium than renin-angiotensin system agents, but lower rates compared to beta-blockers. The findings add to the list of factors which may be considered when choosing antihypertensive drug class.

scholarly journals Compliance Pengguna Antihipertensi di RSUP DR. SARDJITO Yogyakarta (Periode Juli 2006- Juni 2009)

2017 ◽  
Vol 8 (2) ◽  
pp. 70
Author(s):  
Dimas Pramita Nugraha ◽  
Iwan Dwiprahasto ◽  
Jarir At Thobari
Keyword(s):  
Antihypertensive Drugs ◽  
Medication Possession Ratio ◽  
First Year ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Chi Square ◽  
Uncontrolled Blood Pressure ◽  
Cohort Study Design ◽  
Receptor Blockers ◽  
Therapy Of Hypertension

Hypertension is the second largest of the 10 diseases on an outpatient at a hospital in Indonesia. The poor complianceto therapy of hypertension is a major cause of uncontrolled blood pressure. The aim of this study is to determinecompliance antihypertension on patient at DR. Sardjito hospital Yogyakarta. This study was designed with aretrospective cohort study design using a database of participants claimed prescribing health insurance (ASKES) inthe DR. Sardjito hospital using antihypertensive drugs. Compliance measured with medication possession ratio (MPR).Data was analysed by chi- square and logistic regression statistic. From 8.011 patients, compliance of antihypertensivedrugs during the first year is 7,6%. Analysis for compliance showed that the type of antihypertensive diuretics aremore compliance compare with angiotensin II receptor blockers, ACE inhibitors, calcium channel blockers and betablockers. Combination therapy (20,7%) is more compliance than monotherapy ( 4,1%), as well as drugs administration1 time a day (8,2%) is more compliance than drug administration 2 times (2,5%) and 3 times a day (3%). Theproportion of compliance in antihypertensive users at DR. Sardjito hospital classified as less good. Compliancepattern indicates that therapy is not continuous, the longer the use of antihypertensive therapy, the higher thediscontinuous therapy.

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