Korean J Fam Pract. 2017; 7(4): 563-568  https://doi.org/10.21215/kjfp.2017.7.4.563
Utilization Pattern of Anti-Hypertensive Medications according to Comorbidities in a Hospital-Based Family Medicine Practice
Boram Lim, Eunkyo Kang, Seung-hyun Yoo, Sung Sunwoo*
Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Sung Sunwoo
Tel: +82-2-3010-3810, Fax: +82-2-3010-3815
E-mail: sws@amc.seoul.kr
Received: June 22, 2016; Revised: October 4, 2016; Accepted: October 21, 2016; Published online: August 20, 2017.
© Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The prevalence of hypertension (HTN) in Korea has been estimated to be 30.4%, and HTN is the most common comorbidity in patients with diabetes mellitus (DM). The objective of this study was to examine recent trends in antihypertensive drug prescription in a hospital-based family medicine practice. In addition, we evaluated whether these drug utilization patterns follow the recommendations of the latest guidelines for the management of HTN.
Methods: We analyzed the utilization pattern of antihypertensive medications for patients with established HTN (n=964). We reviewed the medical records of patients who visited the outpatient clinic of the Department of Family Medicine of a Asan Medical Center between April 2013 and December 2013. A chi-square test was performed to evaluate the difference in the use of antihypertensive drugs according to comorbidities.
Results: The patients diagnosed as having both HTN and DM were more likely to be treated with combination therapies than those diagnosed as having HTN alone (P=0.003). The most common class of antihypertensive medication prescribed was angiotensin-receptor blockers (ARBs), followed by calcium channel blockers (CCBs), diuretics, and beta-blockers. As monotherapy, ARBs were the most common choice, followed by CCBs. Furthermore, the prescription rate of ARBs was significantly higher in the DM patients. In the patients who received combination therapies, combinations that included ARBs were the most frequent.
Conclusion: The utilization pattern of antihypertensive medications in a hospital-based family medicine practice adheres to the latest guidelines for the management of HTN.
Keywords: Hypertension; Diabetes Mellitus; Drug Utilization Pattern; Primary Care
  1. Korea Health Statistics 2013 : Korea National Health and Nutrition Examination Survey (KNHANES VI-1) [Internet]. Korea Centers for Disease Control, Ministry of Health and Welfare; 2014 Dec 16 [cited 2016 Feb 18].
  2. Jee SH, Appel LJ, Suh I, Whelton PK, Kim IS. Prevalence of cardiovascular risk factors in South Korean adults: results from the Korea Medical Insurance Corporation (KMIC) Study. Ann Epidemiol 1998; 8: 14-21.
  3. Park JK, Kim CB, Kim KS, Kang MG, Jee SH. Meta-analysis of hypertension as a risk factor of cerebrovascular disorders in Koreans. J Korean Med Sci 2001; 16: 2-8.
    Pubmed KoreaMed CrossRef
  4. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112-23.
  5. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992; 19: 403-18.
    Pubmed CrossRef
  6. Shin J. 2013 Korean Society of Hypertension guidelines for the management of hypertension. Clin Hypertens 2015; 21: 2.
    Pubmed KoreaMed CrossRef
  7. Sowers JR, Haffner S. Treatment of cardiovascular and renal risk factors in the diabetic hypertensive. Hypertension 2002; 40: 781-8.
  8. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999; 100: 1134-46.
    Pubmed CrossRef
  9. Association KD. Korea Centers for Disease Control and Prevention. Diabetes fact sheet in Korea, 2012 [Internet]. Seoul: Korean Diabetes Association;2012 [cited 2013 Aug 23].
  10. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension:the National Health And Nutrition Examination Survey, 2001 to 2010. Circulation 2012; 126: 2105-14.
    Pubmed CrossRef
  11. Yoo KB, Lee SG, Park S, Kim TH, Ahn J, Cho MH, et al. Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea. BMJ Open 2015; 5: e006940.
    Pubmed KoreaMed CrossRef
  12. Kim KI, Kim Y, Kim HJ, Kang DH, Park JB, Choi DJ, et al. Current status and characteristics of hypertension treatment by primary physicians in Korea:data from Korean epidemiology study on hypertension (KEY study). Am J Hypertens 2008; 21: 884-9.
    Pubmed CrossRef
  13. Gu Q, Paulose-Ram R, Dillon C, Burt V. Antihypertensive medication use among US adults with hypertension. Circulation 2006; 113: 213-21.
    Pubmed CrossRef
  14. Kim CH, Kim YS, Park YK. Management of hypertension in primary care. Korean J Fam Pract 2012; 2: 8-14.
  15. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002; 288: 2998-3007.
  16. 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: 507-20.
    Pubmed CrossRef
  17. Task Force for the management of arterial hypertension of the European Society of Hypertension; Task Force for the management of arterial hypertension of the European Society of Cardiology. 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Blood Press 2013; 22: 193278.
  18. Casas JP, Chua W, Loukogeorgakis S, Vallance P, Smeeth L, Hingorani AD, et al. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet 2005; 366: 2026-33.
  19. Destro M, Luckow A, Samson M, Kandra A, Brunel P. Efficacy and safety of amlodipine/valsartan compared with amlodipine monotherapy in patients with stage 2 hypertension: a randomized, double-blind, multicenter study:the EX-EFFeCTS Study. J Am Soc Hypertens 2008; 2: 294-302.
    Pubmed CrossRef

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