What question did this study set out to answer?

To examine real-world antihypertensive drug selection, prescription trends over time, and guideline adherence across patient demographics and healthcare facility sizes.

March 6, 2019Hypertension ResearchOpen Access

Analysis of antihypertensive treatment using real-world Japanese data—the retrospective study of antihypertensives for lowering blood pressure (REAL) study

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Why the study?

The actual status of antihypertensive drug selection and the transition in prescription patterns over time had not been fully examined in Japan.

Key Points

To examine real-world antihypertensive drug selection, prescription trends over time, and guideline adherence across patient demographics and healthcare facility sizes.
Retrospective claims-based study analyzing two Japanese administrative databases from 2008 to 2016.
Evaluated prescription patterns across 1,560,865 and 302,433 hypertensive patients, stratified by patient age, comorbidities, and medical institution size.
Calcium channel blockers (CCBs, >60%) and angiotensin II receptor blockers (ARBs, >55%) were the most prescribed drug classes, with CCB use rising and ARB use declining with advancing patient age.
Despite updated 2014 Japanese hypertension guidelines advising against β-blockers as first-line therapy, their prescription rates showed no significant change through 2016.
CCBs were frequently chosen as first-line agents even in patient subgroups with comorbidities where clinical guidelines recommended ARBs or angiotensin-converting enzyme inhibitors.

Structured PICO

Population

1,863,298 hypertensive patients in Japan from two claims databases (n=1,560,865 and n=302,433) between 2008 and 2016.

Intervention

Antihypertensive drug classes (including calcium channel blockers, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, and beta-blockers)

Outcome

Prescription rate for each class of antihypertensive drugs

Real-world prescription patterns for hypertension in Japan show high reliance on CCBs and ARBs, with prescribing practices often lagging behind or diverging from updated clinical guidelines.

Implication

Antihypertensive prescription patterns in Japan characterized over 2008-2016; leaves open impact on outcomes or guideline alignment.

Abstract

Hypertension requires strict treatment because it causes diseases that can lead to death. Although various classes of antihypertensive drugs are available, the actual status of antihypertensive drug selection and the transition in prescription patterns over time have not been fully examined. Therefore, we conducted a claims-based study using two claims databases (2008-16) to determine this status in Japan. We examined the prescription rate for each class of antihypertensive drugs in hypertensive patients and compared the patients' ages and the sizes of the medical institutions treating these patients. Among the 1 560 865 and 302 433 hypertensive patients in each database, calcium channel blockers (CCBs) (>60%) and angiotensin II receptor blockers (ARBs) (>55%) were the most frequently prescribed classes. The prescription rate of CCBs increased and ARBs decreased with the patients' ages. Although the Japanese guidelines for management of hypertension in 2014 changed the recommendation and indicated that β-blockers should not be used as first-line drugs, their prescription status did not change during this study period up to 2016. Use of CCBs and ARBs as first-line drugs differed by the types of patient comorbidities. Although ARBs or angiotensin-converting enzyme inhibitors were recommended for patients with some comorbidities, CCBs were used relatively frequently. In conclusion, the patients' ages and comorbidities and the sizes of the medical institutions affect the selection of antihypertensive drugs. Selection and use of drugs may not always follow the guidelines.