Rational pharmacotherapy in the diabetic hypertension: analysis-prescribing patterns in a general hospital in Taiwan

OBJECTIVES: To examine prescribing at a 2800-bed hospital, also providing ambulatory services for 9000 visits per day, with a view to assessing the extent to which it followed international guidelines for treating diabetic hypertension. METHOD: Patients receiving antidiabetic and antihypertensive drugs concomitantly during the 4-week study period were included. RESULT: Of the 5015 eligible patients, most received combination antidiabetic therapy. Oral antidiabetic agents used alone or in combination included (in descending order) metformin, glibenclamide, gliclazide, glipizide, glimepiride and alpha-glucosidase inhibitors. Gliclazide accounted for most of the oral antidiabetic drug expenditure. Sulfonylurea plus metformin was the most popular regimen. Prescriptions for long-acting sulfonylureas did not differ between elderly and younger patients. For blood pressure control, calcium-channel blockers were most commonly used alone and overall, although current guidelines suggest that they should be second-line treatments. Inappropriate use of immediate-release nifedipine was noted. The combination, atenolol >100 mg/day and hydrochlorothiazide 50 mg/day (or an equivalent) were extensively used. Among 54.7% patients treated with combination antihypertensives, calcium-channel blockers and an angiotensin-converting enzyme inhibitor were most commonly used. CONCLUSION: Most diabetic hypertensive patients were treated with combination therapy for glucose and blood pressure control. Prescriptions for antihypertensive drugs often differed from current guidelines, especially in the choice of agents and their combinations.