Related Experiment Video
Updated: Jan 14, 2026
09:39
Drug-induced Sensitization of Adenylyl Cyclase: Assay Streamlining and Miniaturization for Small Molecule and siRNA Screening Applications
Published on: January 27, 2014
13.1K
High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-II Receptor Blockers (ARBs)
Asinamai M Ndai1,2,3, Kayla Smith1,2,3, Shailina Keshwani1,2,3
1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Pharmacotherapy
|October 21, 2025
Summary
This study identified potential prescribing cascades linked to Angiotensin-II Receptor Blockers (ARBs). Three drug classes, including benzodiazepines, showed significant signals for adverse events in Medicare beneficiaries.
Area of Science:
- Pharmacovigilance
- Drug Safety
- Health Services Research
Background:
- Angiotensin-II Receptor Blockers (ARBs) are widely prescribed medications.
- Adverse events associated with ARBs can lead to a prescribing cascade (PC), where new drugs are prescribed to manage side effects of the initial drug.
Purpose of the Study:
- To identify potential ARB-induced prescribing cascades using high-throughput sequence symmetry analysis.
- To evaluate the association between ARB initiation and subsequent prescription of other drug classes.
Main Methods:
- Utilized Medicare claims data from 2011-2020 for beneficiaries aged 66 years and older.
- Analyzed 446 non-antihypertensive drug classes initiated within ±90 days of ARB initiation.
- Calculated sequence ratios (SRs) and adjusted SRs (aSRs), with number needed to harm (NNTH) for significant signals.
Main Results:
- Identified 320,663 ARB initiators; 17 significant signals were detected among 446 marker classes.
- Three potential PCs were confirmed by clinical experts: benzodiazepine derivatives, adrenergics with anticholinergics (including triple combinations), and other antianemic preparations.
- Benzodiazepine derivatives showed the lowest NNTH (2130) and a significant aSR (1.18).
Conclusions:
- The study identified potential prescribing cascades associated with ARBs, reflecting known and possibly under-recognized adverse events.
- These findings highlight the need for further research into the impact of ARB-induced PCs on patient outcomes.
Keywords:
ARBMedicareadverse eventsantihypertensive medicationsolder adultsprescribing cascadesprescription sequence symmetry analysisMore Related Videos
Related Concept Videos
01:25Antihypertensive Drugs: Direct Renin Inhibitors
1.3K
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
1.3K
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
928
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
928
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
2.4K
In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
2.4K
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
2.3K
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
2.3K
01:28Structure-Activity Relationships and Drug Design
1.7K
Drug design is a dynamic field that involves discovering and developing new medications based on specific biological targets. This process heavily relies on structure-activity relationships (SAR) and quantitative structure-activity relationships (QSAR) to guide the design and optimization of efficient drugs.
SAR studies the intricate relationship between a drug's chemical structure and biological activity. It focuses on understanding how modifications to a drug's structure can influence...
SAR studies the intricate relationship between a drug's chemical structure and biological activity. It focuses on understanding how modifications to a drug's structure can influence...
1.7K
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
436
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
436