Epanolol

Pharmacy claims are commonly used to assess medication adherence. It is unclear how different approaches to handling hospitalizations compare to the gold standard of using outpatient and inpatient drug data. This study aimed to compare the impact of different approaches to handling hospitalizations on medication adherence estimation in administrative claims data.

We identified β-blocker initiators after myocardial infarction (MI) and statin initiators regardless of hospitalization histories in the population-based, Taiwan database, which includes outpatient and inpatient drug claims data. Adherence to β-blockers or to statins during a 365-day follow-up period was estimated in outpatient pharmacy claims using the proportion of days covered (PDC) in three ways: ignoring hospitalizations (PDC1); subtracting hospitalized days from the denominator (PDC2); and assuming drug use on all hospitalized days (PDC3). We compared these to an approach that incorporated inpatient drug use (PDC4). We also used a hypothetical example to examine variations across approaches in several scenarios, such as increasing hospitalized days.

Mean 365-day PDC was 74% among 1729 post-MI β-blocker initiators (range: 73.1%-74.9%) and 44% among 69 435 statins initiators (range: 43.5%-44.0%), which varied little across approaches. Differences across approaches increased with increasing number of hospitalized days. For patients hospitalized for >28 days, mean difference across approaches was >15%. PDC3 consistently yielded the highest value and PDC1 the lowest.

On average, different approaches to handling hospitalizations lead to similar adherence estimates to the gold standard of incorporating inpatient drug use. When patients have many hospitalization days during follow-up, the choice of approach should be tailored to the specific setting.

Background. While all antihypertensive medications lower blood pressure, hemodynamic properties of various classes of antihypertensive medications may differ.Objective. To perform a meta-analysis to compare the hemodynamic properties of different classes of antihypertensive medications.Methods. Studies involving the treatment of hypertension using the effect of ACEIs,β-blockers, CCBs and thiazide diuretics on plasma volume (PV), cardiac output (CO) or stroke volume (SV) were searched using online databases prior to May 2011. Studies had to be written in the English language, studying human subjects with a single pharmacological agent (monotherapy), and with a minimum duration of 4 weeks.Results. Seventy-five (75) studies that enrolled a total of 1522 subjects were included. All four antihypertensive classes lowered blood pressure.β-blockers decreased heart rate; the other classes had no effect upon heart rate. ACEIs increased PV; the other classes had no effect upon PV.β-blockers and thiazide diuretics decreased CO while ACEIs and CCBs had no effect upon CO.β-blockers and CCBs increased SV, thiazide diuretics decreased SV, and ACEIs did not change SV.Conclusion. In the treatment of uncomplicated hypertension, the various classes of antihypertensive medications differ from each other in terms of their non-blood pressure lowering hemodynamic properties.