Trends in Antihypertensive Drug Use in the United States: Do the JNC V Recommendations Affect Prescribing?
Trends in Antihypertensive Drug Use in the United States: Do the JNC V Recommendations Affect Prescribing?
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美国抗高血压药物使用趋势：JNC V 建议会影响处方吗？
DOI：
10.1001/jama.1997.03550210043036
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Julio R Lopez
中科院分区：
文献类型：
--
作者：
D. Siegel;Julio R Lopez
语境。 —美国大约 5000 万高血压患者的药物治疗选择具有重要的治疗和财务影响。目标。 —描述1992年和1995年全国抗高血压药物处方模式；探讨 1993 年发布的第五届全国高血压检测、评估和治疗联合委员会 (JNC V) 的影响，该委员会推荐利尿剂和 β 受体阻滞剂作为一线抗高血压治疗，除非有禁忌症；并估计这些处方模式对抗高血压治疗费用的影响。设计。 — 1992 年和 1995 年 35000 家零售药店批准用于治疗高血压的所有处方药均已制成表格（美国所有零售药店的 62% 接受了调查）。主要成果措施。 —每种药物剂型的处方数量以及基于配药批发成本的国家成本估算。结果。 —1992年，在10种最常用的抗高血压药物中，3种是钙拮抗剂，3种是血管紧张素转换酶（ACE）抑制剂，3种是β受体阻滞剂，1种是氨苯蝶啶和氢氯噻嗪的组合。 1995年，钙拮抗剂4个，ACE抑制剂3个，β受体阻滞剂1个，氨苯蝶啶和氢氯噻嗪联合用药1个，α受体阻滞剂1个。 1992年，钙拮抗剂占抗高血压处方的33%，而1995年为38%，ACE抑制剂的使用从25%增加到33%，β受体阻滞剂的使用从18%增加到11%，利尿剂的使用从16%增加到8%。以 1995 年美元计算，钙拮抗剂的估计批发成本从 1992 年的 26.7 亿美元增加到 1995 年的 28.6 亿美元； ACE抑制剂成本从13.7亿美元增加到16.7亿美元；利尿剂的费用从 3.53 亿美元下降到 1.68 亿美元； β-受体阻滞剂的成本从 7.63 亿美元下降到 4.33 亿美元。结论。 —从 1992 年到 1995 年，用于治疗高血压的钙拮抗剂和 ACE 抑制剂的使用增加，利尿剂和 β 受体阻滞剂的使用减少，这表明 JNC V 的建议对处方模式影响不大。这些实践模式的成本影响是巨大的。
Context. —The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. Objectives. —To describe national antihypertensive medication prescribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V), published in 1993, which recommended diuretics and β-blockers as firstline antihypertensive therapy unless contraindicated; and to estimate the impact of these prescribing patterns on the cost of antihypertensive treatment. Design. —All prescriptions for drugs approved for the treatment of hypertension dispensed by 35000 retail pharmacies were tabulated for 1992 and 1995 (62% of all US retail pharmacies were surveyed). Main Outcome Measures. —Number of prescriptions for each dosage form of medication and national cost estimates based on wholesale costs of medications dispensed. Results. —In 1992, of the 10 most frequently prescribed antihypertensive drugs, 3 were calcium antagonists, 3 were angiotensin-converting enzyme (ACE) inhibitors, 3 were β-blockers, and 1 was the combination of triamterene and hydrochlorothiazide. In 1995,4 were calcium antagonists, 3 were ACE inhibitors, 1 was a β-blocker, 1 was the combination of triamterene and hydrochlorothiazide, and 1 an a-blocker. In 1992, calcium antagonists accounted for 33% of antihypertensive prescriptions compared with 38% in 1995, ACE inhibitor use went from 25% to 33%, β-blocker use from 18% to 11% and diuretic use from 16% to 8%. The estimated wholesale costs for calcium antagonists in 1995 dollars increased from $2.67 billion in 1992 to $2.86 billion in 1995; ACE inhibitor costs increased from $1.37 billion to $1.67 billion; costs for diuretics declined from $353 million to $168 million; and costs for β-blockers declined from $763 million to $433 million. Conclusions. —From 1992 to 1995 use of calcium antagonists and ACE inhibitors for treatment of hypertension increased and diuretics and β-blockers declined, suggesting that the recommendations from JNC V had little effect on prescribing patterns. The cost implications of these practice patterns are enormous.
DOI：
10.1001/jama.1992.03480080053026
发表时间：
1992-02
期刊：
JAMA
影响因子：
--
作者：
D. Siegel;S. Hulley;D. Black;M. Cheitlin;A. Sebastian;D. Seeley;N. Hearst;R. H. Fine
通讯作者：
D. Siegel;S. Hulley;D. Black;M. Cheitlin;A. Sebastian;D. Seeley;N. Hearst;R. H. Fine