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BACKGROUND Noncompliance and nonpersistence to antihypertensive drugs is a recognized worldwide problem. Calcium channel blockers (CCBs) are commonly prescribed among Chinese patients yet few studies have been conducted to study the factors associated with their compliance, discontinuation, and switching profiles. METHODS From clinical databases we studied 20,156 patients prescribed a CCB as their antihypertensive monotherapy from January 2004 to June 2007 in a large Territory of Hong Kong. We evaluated their compliance by medication possession ratios (MPRs), cumulative incidences of discontinuation and switching within 180 days after the prescription; and evaluated their associated factors using multivariable logistic regression analyses. RESULTS The crude compliance level, discontinuation and switching rates at 180 days were 85.0, 3.1, and 5.0%, respectively. Older patients (aged > or =50 years; adjusted odds ratio (aOR) 1.21-1.34, P < 0.001), female gender (aOR 0.89, 95% confidence interval (CI) 0.82-0.96 for males, P = 0.004), fee payers (aOR 1.09, 95% CI 1.00-1.20, P = 0.050), service settings in family medicine specialist clinic (FMSC) (aOR 1.64, 95% CI 1.33-2.01, P < 0.001), and follow-up visits (aOR 3.24, 95% CI 2.93-3.58, P < 0.001) were positively associated with good compliance. Younger age and new visits were significantly associated with drug discontinuation or switching. CONCLUSIONS Younger patients, male subjects, and new visitors were more likely to be noncompliant to CCB among ethnic Chinese. They represent the target subjects where primary care physicians should spend more effort on patient education to improve drug compliance.

background The aim of this study was to investigate trends in the distribution, prevalence, awareness, treatment, and control of hypertension in a Chinese population that has had the fastest growing gross domestic product in the world over the past 3 decades. methods Four standardized cross-sectional health surveys were conducted between 2002 and 2010 in a population consisting of 85 million residents in Guangdong Province. Multistage cluster sampling was adopted to recruit representative samples. The data were obtained through on-site health examinations and face-to-face interviews. results The aging trend in this population was not significant (P = 0.17) during the survey period, whereas body mass index/waist circumference increased significantly (P = 0.047 for body mass index and P

BACKGROUND International guidelines recommending antihypertensive prescriptions for the management of hypertension have been published in the past decade. Beta-blocker use was discouraged by a significant body of evidence and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) were found more effective among younger patients. This study aims to evaluate the trends in prescription profiles in a large Chinese population because patterns of antihypertensive agent dispensation represent important information for physicians and policymakers. METHODS From clinical databases consisting of all patient records in the public health-care system of Hong Kong, we examined all antihypertensive prescriptions according to the drug classes (thiazide diuretics, alpha-blockers, beta-blockers, calcium channel blockers (CCBs), ACEIs, ARBs, fixed-dose combinations, and polytherapy (2, ≥3)) between 2001 and 2010. We retrieved >6.3 million prescription episodes for 223,287 patients. RESULTS The average age of the patients was 59.9 years (SD = 17.6), and 54.8% were women. According to prescription episodes, the most commonly prescribed medications were beta-blockers (31.7%) and CCBs (29.2%), followed by ACEIs (13.9%), thiazide diuretics (5.0%), and alpha-blockers (4.5%). Between 2001 and 2010, the prescription proportions of beta-blockers decreased from 41.5% to 21.5%, whereas that of ARBs increased from 0.5% to 1.0% (P < 0.001, χ(2) test for trend). It was found that the decline of beta-blockers (71.0% to 35.4%) and increase in ARB prescriptions (0.4% to 1.0%) were particularly marked among younger subjects aged

Background Hypertension is the most important risk factor for cardiovascular diseases. Little information exists on the status of hypertension among southern Chinese. We therefore investigated the hypertension prevalence, awareness, treatment, control, and associated factors in a southern Chinese population with 85 million residents. Methods Stratified multistage cluster sampling with probability proportional to size method was used in this survey. A representative sample of 13,889 residents aged 20 years or above with completed questionnaire and blood pressure (BP) measurement was obtained. BP was measured in accordance with the 1999 World Health Organization/International Society of Hypertension Guidelines. Information related to history of diagnosis and treatment of hypertension was collected through questionnaire. Results The prevalence of hypertension in this population was 20.5% (16.5%, 24.4%), which translated to 9.8 million adults suffering from hypertension in Guangdong province. The urban population had higher prevalence of hypertension than the rural population (25.1 vs. 16.1%). The prevalence of awareness, treatment, and control of hypertension in hypertensive patients living in urban regions were 42.8, 37.9, and 13.5%, respectively, which were higher than those in rural regions (the corresponding figures were 17.6, 10.4, and 3.4%, respectively). Nearly 50% urban adults and 80% rural adults did not measure their BP in the last 12 months. Frequency of BP measurement was associated with both awareness and treatment. Conclusions Hypertension was prevalent in southern China. The prevalence of awareness, treatment, and control of hypertension is low. Urgent strategies are needed to improve prevention, detection, and treatment of hypertension in this large Chinese population.

BACKGROUND Antihypertensive drug discontinuation imposes a substantial health services burden but few studies have addressed the factors associated with theirdiscontinuation in Chinese patients.This study evaluated the association between age, gender, and drug classes with antihypertensive discontinuation. METHODS From clinical databases, we included all adult patients prescribed an antihypertensive medication during January 2004 to June 2007 in one large territory of Hong Kong. We studied the factors associated with drug discontinuation within 180 days after the first prescription date by multivariable regression analysis. RESULTS From 93,286 eligible patients, 13.2% discontinued their antihypertensive prescriptions. Younger (

International guidelines on management of hypertension recommend any major classes of antihypertensive drugs. However, the low prescribing rate of thiazides has been attributed to concerns about electrolyte disturbances and studies between antihypertensive drug classes and hyponatremia/hypokalemia among Chinese patients were scarce.From clinical databases we included 2,759 patients who received their first-ever antihypertensive monotherapy from January 2004 to June 2007 in a large territory of Hong Kong. We studied the plasma sodium and potassium levels 8 weeks after prescriptions and factors associated with hyponatremia and hypokalemia by multivariable regression analyses.Among major antihypertensive drug classes, thiazide users had the lowest sodium level (139.6 mEq/l, 95% confidence interval (CI) 139.3, 140.0, P0.001) and patients-prescribed calcium channel blockers (CCBs; 3.92 mEq/l, 95% CI 3.89, 3.95) or thiazide diuretics (3.99 mEq/l, 95% CI 3.93, 4.04) had the lowest potassium levels (P0.001). Multivariate analysis reported that advanced age (or =70 years, odds ratio (OR) 7.49, 95% CI 2.84, 19.8, P0.001), male gender (OR 2.38, 95% CI 1.45, 3.91, P0.001), and thiazide users (OR 2.42, 95% CI 1.29, 4.56, P = 0.006) were significantly associated with hyponatremia, while renin-angiotensin system (RAS) (OR 0.31, 95% CI 0.13, 0.73, P = 0.008) and beta-blockers (BBs) (OR 0.35, 95% CI 0.23, 0.54, P0.001) users were less likely to present with hypokalemia. However, the proportions having normonatremic (95.1%) and normokalemic (89.4%) levels were high.In view of the low prevalence of hyponatremia and hypokalemia associated with thiazides, physicians should not be deterred from prescribing thiazide diuretics as first-line antihypertensive agents as recommended by most international guidelines.