Use of Prescription Medications That Potentially Interfere With Blood Pressure Control in New-Onset Hypertension and Treatment-Resistant Hypertension.
Use of Prescription Medications That Potentially Interfere With Blood Pressure Control in New-Onset Hypertension and Treatment-Resistant Hypertension.
复制标题
在新发高血压和难治性高血压中使用可能干扰血压控制的处方药。
DOI：
10.1093/ajh/hpy118
复制
发表时间：
2018
影响因子：
3.2
通讯作者：
Smith,StevenM
中科院分区：
文献类型：
--
作者：
Hwang,AndrewY;Dave,ChintanV;Smith,StevenM
建议血压不受控制的患者停用干扰血压（BP）的药物，但在高血压患者中，此类药物的实际使用并没有很好的特征。我们的目的是评估使用BP干扰处方药在美国患者hypertension. METHODS本回顾性药物利用研究使用的医疗和处方索赔（2008年1月至2014年12月）在MarketScan商业索赔数据库。我们纳入了年龄在18-65岁之间、诊断为高血压（国际疾病分类，第九次修订版，代码401）和服用≥1次降压药物的成人。两个高血压队列进行了检查-新的抗高血压药物使用者（高血压事件）和患者需要滴定到第四个抗高血压（难治性高血压事件[TRH]）。在索引日期之前和之后6个月评估患者水平的BP干扰药物暴露，索引日期定义为抗高血压药物的首次处方填写或≥4种抗高血压药物的首次重叠使用。最常见的BP干扰处方药是非甾体抗炎药（NSAID）、对乙酰氨基酚和激素。总体而言，18.3%的高血压事件队列和17.6%的TRH事件队列在降压药滴定后开始使用BP干扰药物。在以前服用BP干扰药物的患者中，57.6%的事件高血压和64.9%的事件TRH再填充药物后，抗高血压enhancement. CONCLUSIONSSThe使用处方BP干扰药物，特别是非甾体抗炎药，是普遍的患者需要加强他们的抗高血压方案。在可行的情况下，可能需要在不受控制的高血压患者中更努力地限制这些药物的使用。
BACKGROUNDWithdrawing medications that interfere with blood pressure (BP) is recommended in patients with uncontrolled BP, yet real-world use of such agents is not well characterized among individuals with hypertension. We aimed to evaluate the use of BP-interfering prescription medications among US patients with hypertension.METHODSThis retrospective drug utilization study used medical and prescription claims (January 2008 to December 2014) in the MarketScan commercial claims database. We included adults, aged 18–65 years, with a hypertension diagnosis (International Classification of Diseases, Ninth Revision, code 401) and ≥1 antihypertensive medication fill. Two hypertension cohorts were examined—new antihypertensive drug users (incident hypertension) and patients requiring titration to a fourth antihypertensive (incident treatment-resistant hypertension [TRH]). Patient-level exposure to BP-interfering medications was assessed 6 months before and after the index date, defined as the first prescription fill of an antihypertensive drug or the first occurrence of overlapping use of ≥4 antihypertensive drugs.RESULTSWe identified 521,028 patients with incident hypertension and 131,764 patients with incident TRH. The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones. Overall, 18.3% of the incident hypertension cohort and 17.6% of the incident TRH cohort initiated a BP-interfering medication following antihypertensive titration. Among patients previously taking a BP-interfering medication, 57.6% with incident hypertension and 64.9% with incident TRH refilled that medication after antihypertensive intensification.CONCLUSIONSThe use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen. Greater efforts to limit the use of these medications, where feasible, may be required among patients with uncontrolled hypertension.