Rational pharmacotherapy in patients of diabetes with hypertension: Analysis prescribing patterns in a medical center in Taiwan

• Main Authors: Cheng Sue-Fei, 鄭淑妃
• Other Authors: Lin Chung-Sheng, MD, Ph.D.
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/41560476666753669365

碩士 === 中山醫學大學 === 醫學研究所 === 92 === Abstract Aims Diabetes mellitus increases the prevalence of hypertension twofold, and the coexistence of these diseases creates a high risk for macrovascular and microvascular complications. The treatment of hypertension in diabetes remains a consistent research issue. Patients with diabetes tend to use many drugs, particularly cardiovascular agents. Our purpose was to determine the prescription patterns for diabetic hypertensive patients in a Taiwanese medical center and compare them with current guidelines. Methods Patients presenting with a prescription for the month of January 2001 were collected if any antidiabetic concomitantly antihypertensive agent. Patients with angina pectoris, benign prostate hyperplasia, congestive heart failure, dysrhythmias, migraine or thyroid dysfunction were excluded. Statistical analysis was performed using the Statistical Package for Social Science. Results are expressed as mean±SD. Chi-square and Student t tests were used to determine differences between proportions and means All tests were two-sided, and statistical significance was assumed at P < 0.05. Results and Discussion A total of 5015 patients were collected during the one-month study. Each prescription included 5.7 ± 2.1 drugs. Patient ≥65 years were prescribed more drugs than those <65 years. (5.8 ± 2.1 vs 5.6 ± 2.1) Sulfonylurea plus metformin was the most popular regimen. Prescriptions for long-acting sulfonylureas did not differ between elderly and younger patients. Expenditure analysis showed that gliclazide accounted for 40.1% of the total costs for oral antidiabetics, though its utilization represented only 15.1% of all oral antidiabetics. For hypertension, 2322 (46.3%) patients received monotherapy. Combination therapy included two (1823, 36.4%), three (691, 13.8%), four (153, 3.1%) or five (26, 0.5%) drugs. The most popular combination was a calcium-channel blockers(CCBs) plus an angiotensin-converting enzyme (ACE) inhibitor. CCBs (3395, 38.0%) were most often prescribed, both as monotherapy and overall, despite guidelines suggesting that CCBs should be second-choice agents. Inappropriate use of immediate-release nifedipine was found. The prescription rate of ACE inhibitors (2108, 23.6%) was lower than expected, though strong evidence supports their use as the preferred class in diabetic hypertensive patients. Atenolol over 100 mg/day and hydrochlorothiazide 50 mg/day (or an equivalent) were extensively used. Conclusion Most our diabetic hypertensive patients need combination therapy for glucose and blood pressure control. Because diabetes is progressive, combination treatment is logical. This prescription survey not only showed the patterns of drug utilization by diabetic hypertension and the distribution of expenditures for these drugs, but also revealed some of the inappropriate prescriptions. Prescribing patterns were relatively consistent with guidelines for diabetic therapy but not with guidelines for hypertension therapy. More studies are required to correlate these findings with clinical outcomes and cost-effectiveness.