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
Journal
Acta Cardiologica Sinica
Journal Volume
29
Journal Issue
1
Pages
49-55
Date Issued
2013
Author(s)
Hsu C.-N.
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 amore 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: na?ve, switch, and add-on. The increase in patients taking SPCs came mostly from the na?ve 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 na?ve and add-on SPC users, patients in the switch group had a greater pill burden and more comorbidities, whichmight drive physicians to switch from free combinations to SPCs. Conclusions: Single-pill combinations are well-accepted and increasingly prescribed in Taiwan, particularly in drug-na?ve hypertensive patients. This finding might indicate an aggressive attitude towards early hypertension control among physicians in Taiwan.
Subjects
Angiotensin receptor blocker; Angiotensin-converting enzyme inhibitor; Diuretic; Hypertension; Single-pill combinations
SDGs
Other Subjects
angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; thiazide diuretic agent; adult; controlled study; data base; female; human; hypertension; male; medical record review; national health insurance; physician; prescription; reimbursement; review; Taiwan; trend study
Type
review