Secular Trends in Prescription Patterns of Single-Pill Combinations of an Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Plus a Thiazide Diuretic for Hypertensive Patients in Taiwan
Resource
Acta Cardiol. Sin., 29(1), 49-55
Journal
Acta Cardiol. Sin.
Journal Volume
29
Journal Issue
1
Pages
49-55
Date Issued
2013
Date
2013
Author(s)
Hsu, Chih-Neng
Wang, Tzung-Dau
Abstract
Background: Poor adherence to recommended drug regimens is one of the fundamental issues behind suboptimal control rates of hypertension worldwide. Single-pill combinations (SPCs) improve patient adherence, decrease cost, and are increasingly prescribed in the Western societies. We conducted this study to elucidate the prescription patterns and the secular trends of SPCs in Taiwan.
Methods: We retrospectively reviewed the reimbursement database of Taiwan's National Health Insurance from 2002 to 2007. Among the one million-person random samples, information from those coded with ICD-9 401-405 and antihypertensive prescriptions was obtained.
Results: From 2002 to 2007, there had been a more than 7.5-fold increase in annual prescription frequency of SPCs of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus a thiazide diuretic (from 1.1% to 8.5%, p < 0.001) among 302,628 hypertensive patients. Likewise, among patients treated with at least ACEIs or ARBs and diuretics, the relative proportion of SPC use, in contrast to free combinations, increased markedly (from 10.8% to 54.2%, p = 0.005). Incorporating patient antihypertensive treatment prior to SPCs prescription, we categorized the SPC prescription patterns into 3 groups: naive, switch, and add-on. The increase in patients taking SPCs came mostly from the naive SPC prescription group (from 2.3% in 2002 to 28.8% in 2007 among all patients treated with ACEIs or ARBs and thiazide diuretics, p = 0.003). Compared to both naive and add-on SPC users, patients in the switch group had a greater pill burden and more comorbidities, which might drive physicians to switch from free combinations to SPCs.
Conclusions: Single-pill combinations are well-accepted and increasingly prescribed in Taiwan, particularly in drug-naive hypertensive patients. This finding might indicate an aggressive attitude towards early hypertension control among physicians in Taiwan.
Subjects
Angiotensin-converting enzyme inhibitor
Angiotensin receptor blocker
Diuretic
Hypertension
Single-pill combinations
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