Skip to main content
SpringerLink
Log in

Trends of antihypertensive agents in patients with hypertension and coronary artery disease in a tertiary hospital of China

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Except for hypertension control, antihypertensive agents play an essential role in the secondary prevention of coronary artery disease. Objective This study aimed to describe the use of antihypertensive agents in patients with hypertension and coronary artery disease by assessing the compliance to the updated European and Chinese hypertension guidelines through analyzing the frequencies, monthly trends and the influencing factors of antihypertensive agents. Setting Beijing Friendship Hospital, Capital Medical University, a 2000-bed tertiary Chinese university teaching hospital. Method Prescriptions of patients diagnosed with hypertension and coronary artery disease were extracted from medical records of this tertiary hospital from 2013 to 2016. Frequencies, trends, co-existing prescription patterns of five classes of antihypertensive agents were analyzed. Influencing factors of prescription patterns were evaluated by logistic regression. Main outcome measure The frequencies and monthly trends of different antihypertensive agents within four years. Result In total, 286,155 prescriptions met the inclusion criteria. β-blockers (64,0%) were the most widely used antihypertensive agents, followed by calcium channel blockers (53.57%), angiotensin receptor blockers (42.6%), angiotensin-converting-enzyme inhibitors (23.7%) and diuretics (16.4%). During the 4 years, frequencies of β-blockers, angiotensin receptor blockers, calcium channel blockers and diuretics increased over time, while that of angiotensin-converting-enzyme inhibitors declined. Multivariate logistic regression indicated that gender, age and comorbidities including stroke, diabetes, heart failure and arrhythmia could affect antihypertensive selections to varying degrees. Conclusion The compliance to guidelines is overall well for patients with hypertension and coronary artery disease, but improvements is needed for patients with type 2 diabetes. Multi-center studies with large-scale data are required to further assess the usage of antihypertensive agents in patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Xu H, Li W, Yang J, Wiviott SD, Sabatine MS, Peterson ED, et al. The China acute myocardial infarction (cami) registry: a national long-term registry-research-education integrated platform for exploring acute myocardial infarction in China. Am Heart J. 2016;175:193–201.

    Article  PubMed  Google Scholar 

  2. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  3. China Society of Cardiology of Chinese Medical Association. Guideline on the diagnosis and therapy of ST-segment elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi. 2015;43:380–93.

    Google Scholar 

  4. Chinese Society of Cardiology of Chinese Medical Association. Guideline and consensus for the management of patients with non-ST-elevation acute coronary syndrome(2016). Zhonghua Xin Xue Guan Bing Za Zhi. 2017;45:359–76.

    Google Scholar 

  5. Dagenais G, Pogue J, Fox K, Simoons ML, Yusuf S. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet. 2006;368(9535):581–8.

    Article  CAS  PubMed  Google Scholar 

  6. Law MR, Morris JK, Wald NJ. use of blood pressure lowering drugs in the prevention of cardiovascular disease: a meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Joint Committee for Guideline Revision. 2018 chinese guidelines for prevention and treatment of hypertension-a report of the revision committee of chinese guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019;16(3):182–241.

    PubMed Central  Google Scholar 

  8. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:e127–248.

    Article  PubMed  Google Scholar 

  9. Sundström J, Arima H, Jackson R, Turnbull F, Rahimi K, Chalmers J, et al. Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med. 2015;162(3):184–91.

    Article  PubMed  Google Scholar 

  10. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–67.

    Article  PubMed  Google Scholar 

  11. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the european society of cardiology and the european society of hypertension. Eur Heart J. 2018;39(33):3021–104.

    Article  Google Scholar 

  12. Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, et al. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the american heart association, american college of cardiology, and american society of hypertension. Circulation. 2015;131(19):e435–70.

    Article  PubMed  Google Scholar 

  13. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. J Thorac Cardiovasc Surg. 2015;149(3):e5–23.

    Article  PubMed  Google Scholar 

  14. Muntner P, Krousel-Wood M, Hyre AD, Stanley E, Cushman WC, Cutler JA, et al. Antihypertensive prescriptions for newly treated patients before and after the main antihypertensive and lipid-lowering treatment to prevent heart attack trial results and seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure guidelines. Hypertension. 2009;53(4):617–23.

    Article  CAS  PubMed  Google Scholar 

  15. Frazier CG, Shah SH, Armstrong PW, Bhapkar MV, McGuire DK, Sadowski Z, et al. Prevalence and management of hypertension in acute coronary syndrome patients varies by sex: observations from the Sibrafiban versus aspirin to Yield maximum protection from ischemic heart events postacute coronary syndromes (symphony) randomized clinical trials. Am Heart J. 2005;150(6):1260–7.

    Article  CAS  PubMed  Google Scholar 

  16. Lin Y, Pan W, Ning S, Song X, Jin Z, Lv S. Prevalence and management of hypertension in patients with acute coronary syndrome vary with gender: observations from the chinese registry of acute coronary events (CRACE). Mol Med Rep. 2013;8:173–7.

    Article  CAS  PubMed  Google Scholar 

  17. Larochelle P, Tobe SW, Lacourcière Y. β-Blockers in hypertension: studies and meta-analyses over the years. Can J Cardiol. 2014;30:S16–22.

    Article  PubMed  Google Scholar 

  18. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment. 6. prevention of heart failure and new-onset heart failure–meta-analyses of randomized trials. J Hypertens. 2016;34(3):373–84.

    Article  CAS  PubMed  Google Scholar 

  19. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/ACC guideline for the management of patients with non–st-elevation acute coronary syndromes: executive summary: a report of the american college of cardiology/american heart association task force on practice guidelines. Circulation. 2014;130:2354–94.

    Article  PubMed  Google Scholar 

  20. Chinese Society of Cardiology of Chinese Medical Association. Guideline of non-ST segment elevation acute coronary syndrome. Zhonghua Xin Xue Guan Bing Za Zhi. 2012;40:353–67.

    Google Scholar 

  21. Damman P, van’t Hof A, Ten Berg JM, Jukema JW, Appelman Y, Liem H, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: comments from the Dutch ACS working group. Neth Heart J. 2015;2017(25):181–5.

    Google Scholar 

  22. Jarred G, Kennedy RL. Therapeutic perspective: starting an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in a diabetic patient. Ther Adv Endocrinol Metab. 2010;1:23–8.

    Article  PubMed  Google Scholar 

  23. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the american heart association and the american diabetes association. Diabetes Care. 2007;30(1):162–72.

    Article  CAS  PubMed  Google Scholar 

  24. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the american heart association and the american diabetes association. Diabetes Care. 2015;38(9):1777–803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Guoliang Zhao and Hong Zhang from the Cardiovascular Center Beijing Friendship Hospital Database Bank for their help in data extraction and cleaning.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Yingming Zheng and Dandan Li have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, China

    Yingming Zheng, Dandan Li, Heng Guo & Su Shen

  2. Clinical Epidemiology and EBM Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Na Zeng

  3. National Clinical Research Center for Digestive Disease, Beijing, China

    Na Zeng

  4. Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Hongwei Li

  5. Key Laboratory, Metabolic Disorders Related Cardiovascular Disease, Capital Medical University, Beijing, China

    Hongwei Li

  6. Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Hongwei Li

  7. Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, China

    Hongwei Li

Authors
  1. Yingming Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dandan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Na Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heng Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hongwei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Su Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Su Shen.

Ethics declarations

Conflicts of interest

The authors have nothing to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 66 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, Y., Li, D., Zeng, N. et al. Trends of antihypertensive agents in patients with hypertension and coronary artery disease in a tertiary hospital of China. Int J Clin Pharm 42, 482–488 (2020). https://doi.org/10.1007/s11096-020-00986-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-00986-6

Keywords

Search

Navigation