Uptake of angiotensin II receptor blockers in the treatment of hypertension.
OBJECTIVE
To examine trends in prescribing of angiotensin II receptor blockers (ARBs) as initial and second-line treatment of hypertension.


METHODS
We performed a cohort study in the Integrated Primary Care Information database, a general practice research database in The Netherlands. We included hypertensive patients who were newly treated with antihypertensive drugs between 1996 and 1999. Initial treatment was defined as the first prescribed antihypertensive drug after diagnosis of hypertension. As second-line treatment, we considered prescriptions of a second antihypertensive drug class, either as switch or addition. We used logistic regression and Cox proportional hazard analysis to estimate time trends in use of ARBs as initial or second-line treatment.


RESULTS
In total, 8% of the 3,102 newly treated hypertensive patients received ARBs as initial treatment. Initial ARB use increased significantly from 4% to 10% during the period 1996-1999, whereas calcium channel blocker and angiotensin-converting enzyme inhibitor (ACE-I) use decreased. ARBs were used as second-line treatment in less than 4% of 2,544 patients who were initially treated with an antihypertensive drug other than an ARB: 2% switched to an ARB (mostly from ACE-Is) and 1% received ARBs as add-on treatment. Diuretics and beta-blockers were used five to ten times more often as add-on treatment than ARBs.


CONCLUSIONS
ARBs achieved a position in the treatment of hypertension as initial rather than second-line therapy.
Greving
Jacoba P
JP
Department of Clinical Pharmacology, University Medical Center Groningen, PO Box 196, 9700, AD, Groningen, The Netherlands. j.p.greving@med.umcg.nl
Denig
Petra
P
van der Veen
Willem Jan
WJ
Beltman
Frank W
FW
Sturkenboom
Miriam C J M
MC
de Zeeuw
Dick
D
Haaijer-Ruskamp
Flora M
FM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents