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Antihypertensive Drug Therapy in Saskatchewan
Patterns of Use and Determinants in Hypertension
Chantal Bourgault, PhD;
Bruno Rainville, MSc;
Samy Suissa, PhD
Arch Intern Med. 2001;161:1873-1879.
Background The benefits of continuous treatment of hypertension have been extensively
documented in randomized controlled trials. However, clinical trials may not
reflect actual drug use in the population.
Objective To examine the distribution and determinants of patterns of use of antihypertensive
agents in the first 5 years of hypertension treatment in Saskatchewan.
Methods Patterns of use and modifications to therapy were derived from a careful
examination of medication use in a cohort of 19 501 subjects aged 40
to 79 years, without recognized cardiac disease and initiating therapy with
an angiotensin-converting enzyme inhibitor, a calcium antagonist, or a ß-blocker
in Saskatchewan between 1990 and 1993.
Results Angiotensin-converting enzyme inhibitors (37.4%), followed by calcium
antagonists (27.5%) and ß-blockers (26.4%), were the most commonly prescribed
agents to initiate treatment in our study population. Patients with diabetes
were less likely to be dispensed a ß-blocker, as were younger and female
patients. Previous visits to a cardiologist decreased the likelihood of receiving
combination therapy or angiotensin-converting enzyme inhibitors but increased
that of using calcium antagonists. Apart from dose adjustment, 89% of study
subjects underwent at least 1 modification to their initial regimen, at a
median time of 134 days. After 1 year, only 33.8% of patients were still using
their initial drug. An early decrease in the proportion of patients continuing
to receive initial therapy was noted, especially among ß-blocker users.
Conclusions Erratic drug-taking behaviors were observed in this Saskatchewan population.
In addition, initial drug use does not seem to be in accordance with the stepped-care
approach to hypertension therapy recommended in the Canadian guidelines.
From the Department of Epidemiology and Biostatistics, McGill University
(Drs Bourgault and Suissa), and Pharmacoepidemiology Research Unit, Division
of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health
Centre (Drs Bourgault and Suissa and Mr Rainville), Montreal, Quebec.
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