| アブストラクト | AIM: Angiotensin-converting enzyme inhibitors (ACEIs) are widely prescribed for several cardiovascular indications. This study investigated patterns of ACEI use for various indications. METHODS: A descriptive, retrospective population-based study was conducted using data from the UK Clinical Practice Research Datalink. Patients starting ACEIs (2007-2014) were selected and ACEI indications were retrieved from electronically recorded medical records. Stratified by indication, we distinguished between persistent and nonpersistent ACEI use, considering a 6-month interval between two prescription periods as a maximum for persistent use. Five-year persistence rates for various indications were calculated using the Kaplan-Meier method and compared in a log-rank test. Nonpersistent users were subdivided into three groups: (i) stop; (ii) restart; and (iii) switch to an angiotensin II-receptor blocker. Patients who received ACEIs for hypertension who switched to other classes of antihypertensive medications were further investigated. RESULTS: In total, 254 002 ACEI initiators were identified with hypertension (57.6%), myocardial infarction (MI; 4.2%), renal disease (RD; 3.7%), heart failure (HF; 1.5%), combinations of the above (17.2%) or none of the above (15.8%). Five-year persistence rates ranged from 43.2% (RD) to 68.2% (MI; P < 0.0001). RD and HF patients used ACEIs for the shortest time (average 23.6 and 25.0 months, respectively). For the nonpersistent group, the percentage of switchers to angiotensin II-receptor blockers ranged from 27.6% (RD) to 42.2% (MI) and the restarters ranged from 15.0% (HF) to 18.1% (group without indication). CONCLUSIONS: Depending on the indication, there are various rates of ACEI nonpersistence. Patients with RD are most likely to discontinue treatment. |
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| 組織名 | Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for;Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.;Institute for Medical Biostatistics, Epidemiology, and Informatics (IMBEI),;Department of Biometry and Bioinformatics, University Medical Centre of the;Johannes Gutenberg University, Mainz, Germany.;Center for Thrombosis and Hemostasis (CTH), University Medical Centre of the;Department of Cardiology, Division Heart & Lungs, University Medical Center;Utrecht, University of Utrecht, the Netherlands.;Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht,;the Netherlands.;Institute of Cardiovascular Science, Faculty of Population Health Sciences,;University College London, London, UK.;Farr Institute of Health Informatics Research and Institute of Health;Informatics, University College London, London, UK.;Department of Respiratory Medicine, Academic Medical Centre, University of;Amsterdam, Amsterdam, the Netherlands. |
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