Characterizing Dual Combination Therapy Use in Treatment Escalation of Hypertension: Real-World Evidence from Multinational Cohorts
Characterizing Dual Combination Therapy Use in Treatment Escalation of Hypertension: Real-World Evidence from Multinational Cohorts
ABSTRACT BackgroundOver one billion adults have hypertension globally, of whom approximately 70% cannot achieve blood pressure control goal with monotherapy alone. Data are lacking on patterns of dual combination therapies prescribed to patients who escalate from monotherapy in routine practice. MethodsUsing eleven electronic health record databases that cover 118 million patients across eight countries/regions, we characterized the initiation of antihypertensive dual combination therapies for patients with hypertension. In each database, we first constructed twelve exposure cohorts of patients who newly initiate dual combination therapy with one of the four most commonly used antihypertensive drug classes (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin receptor blocker [ARB]; calcium channel blocker [CCB]; beta-blocker; and thiazide or thiazide-like diuretic) after escalating from monotherapy with one of the three alternative classes. Using these cohorts, we then described dual combination therapy utilization, stratified by age, gender, history of cardiovascular diseases (CVD), and country. ResultsAcross data sources, we identified 980,648 patients with hypertension initiating dual combination therapy with antihypertensive agents after escalating from monotherapy: 12,541 from Australia, 6,980 from South Korea, 2,096 from Singapore, 7,008 from China, 16,663 from Taiwan, 103,994 from France, 76,082 from Italy, and 754,137 from the United States (US). Significant variations in treatment utilization existed across countries and patient subgroups. In Australia and Singapore, starting an ACEi/ARB monotherapy followed by a CCB was most common while in South Korea, China and Taiwan, starting a CCB monotherapy followed by an ACEi/ARB was most common. In Italy, France, and the US, sequential use of an ACEi/ARB monotherapy followed by a diuretic was most common. Younger patients were more likely to be prescribed ACEi/ARB followed by either a CCB or a diuretic compared with older patients. Women were more likely to be prescribed diuretics then an ACEi/ARB or a CCB compared with men. Among patients with history of CVD, ACEi/ARB followed by beta-blocker, and beta-blocker followed by ACEi/ARB were more commonly prescribed. ConclusionThis is the largest and most comprehensive study characterizing the real-world utilization of dual combination therapies in treating hypertension. Large variation in the transition between monotherapy and dual combination therapy for hypertension was observed across countries. These results highlight the need for future research to identify which second-line dual combination therapy is most effective in practice.
Lu Yuan、Cho Jaehyeong、Dorajoo Sreemanee Raaj、Hsu Jason C.、Iqbal Usman、Jason Chen Zhengfeng、Li Yu-Chuan、Lim Hong-Seok、Ngiam Kee Yuan、Nguyen Phung-Anh、Park Rae Woong、You Seng Chan、Pratt Nicole、Rhee Sang Youl、Kumaran Sathappan Selva Muthu、Xu Hua、Wang Xialin、Krumholz Harlan、Hsu Min-Huei、Liaw Siaw-Teng、Hwang Jiyoung、Reich Christian、Li Jing、Feng Mengling、Suchard Marc、Shin Seo Jeong、Tan Hui Xing、Zhang Xin、Liu Yun、Van Zandt Mui、Jonnagaddala Jitendra
Center for Outcomes Research & Evaluation (CORE), Yale UniversityDepartment of Biomedical Sciences, Ajou University Graduate School of MedicineHealth Sciences Authority, Singapore and Khoo Teck Puat HospitalInternational PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical UniversityTaipei Medical UniversityNational University Heart Center and Yong Loo Lin School of Medicine, National University of SingaporeTaipei Medical UniversityDepartment of Cardiology, Ajou University School of MedicineGroup Chief Technology Office, National University Health SystemInternational Center for Health Information Technology, Taipei Medical University and Taiwan Department of Healthcare Information and Management, School of Health Technology, Ming Chuan UniversityDepartment of Biomedical Informatics, Ajou University School of Medicine Department of Biomedical Sciences, Ajou University Graduate School of MedicineDepartment of Preventive Medicine, Yonsei University College of MedicineQuality Use of Medicines and Pharmacy Research Center, Clinical and Health Sciences, University of South Australia, AdelaideKyung Hee University Medical CenterSaw Swee Hock School of Public Health, National University Health System and National University of SingaporeThe University of Texas Health Science Center at HoustonReal World SolutionsCenter for Outcomes Research & Evaluation (CORE), Yale UniversityTaipei Medical UniversityWHO Collaborating Center on eHealth, School of Population HealthAjou University School of MedicineReal World SolutionsReal World SolutionsSaw Swee Hock School of Public Health, National University Health System and National University of Singapore and Institute of Data Science, National University of SingaporeDepartment of Biostatistics, UCLA Fielding School of Public Health, University of CaliforniaDepartment of Biomedical Sciences, Ajou University Graduate School of MedicineHealth Sciences AuthorityDepartment of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical UniversityDepartment of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical UniversityReal World SolutionsWHO Collaborating Center on eHealth, School of Population Health
医学研究方法内科学
Lu Yuan,Cho Jaehyeong,Dorajoo Sreemanee Raaj,Hsu Jason C.,Iqbal Usman,Jason Chen Zhengfeng,Li Yu-Chuan,Lim Hong-Seok,Ngiam Kee Yuan,Nguyen Phung-Anh,Park Rae Woong,You Seng Chan,Pratt Nicole,Rhee Sang Youl,Kumaran Sathappan Selva Muthu,Xu Hua,Wang Xialin,Krumholz Harlan,Hsu Min-Huei,Liaw Siaw-Teng,Hwang Jiyoung,Reich Christian,Li Jing,Feng Mengling,Suchard Marc,Shin Seo Jeong,Tan Hui Xing,Zhang Xin,Liu Yun,Van Zandt Mui,Jonnagaddala Jitendra.Characterizing Dual Combination Therapy Use in Treatment Escalation of Hypertension: Real-World Evidence from Multinational Cohorts[EB/OL].(2025-03-28)[2025-07-16].https://www.medrxiv.org/content/10.1101/2021.06.28.21258167.点此复制
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