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Differences in Antihypertensive Medication Prescription Profiles Between 2009 and 2021: A Retrospective Cohort Study
Victoria Ivensky1,2, Pitchou Zonga3, Gabriel Dallaire1,4
1Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'île-de-Montréal, QC, Canada.
Insights
Hypertension medication prescribing in Quebec shows suboptimal adherence to guidelines, with limited use of optimal drug combinations. Education initiatives are needed to improve blood pressure control rates in Canada.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Blood pressure (BP) control is crucial for preventing cardiovascular diseases.
- Hypertension control rates in Canada are declining.
- Antihypertensive medication prescription patterns in Quebec require evaluation.
Purpose of the Study:
- To assess changes in antihypertensive medication prescription profiles in Quebec from 2009 to 2021.
- To identify trends in guideline-recommended drug use for hypertension management.
Main Methods:
- Retrospective cohort study using CARTaGENE data linked to administrative health databases.
- Analysis of antihypertensive drug prescription profiles at enrollment (2009-2010) and end of follow-up (March 2021).
- Comparison of prescription practices using chi-square tests, with sensitivity analysis excluding non-hypertension indications.
Main Results:
- Prescription rates for antihypertensive drugs increased from 31.4% to 51.3% between study periods.
- Guideline-recommended monotherapy remained prevalent (77.9% vs 79.5%), while optimal 2- and 3-drug combinations were underutilized.
- Increased use of long-acting thiazide-like diuretics and spironolactone was observed but remained infrequent.
Conclusions:
- Antihypertensive drug prescribing in Quebec demonstrates suboptimal application of hypertension guidelines.
- There is a need for targeted education initiatives to improve prescribing practices.
- Enhancing adherence to guidelines may contribute to improved blood pressure control rates in Canada.
Background:
Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline.
Objective:
To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021.
Design:
This is a retrospective cohort study.
Setting:
We used data from the CARTaGENE population-based cohort linked to administrative health databases.
Patients:
Participants with any drug claim in the 6 months prior to the end of follow-up were included.
Measurements:
Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021).
Methods:
Prescriptions practices from the 2 time periods were compared using Pearson's chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up).
Results:
Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis.
Limitations:
Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available.
Conclusions:
Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.
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