Parts of this work were presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 11th Annual International Meeting, Philadelphia, PA, USA, May 2006, and at the Academy Health Annual Research Meeting, Seattle, WA, USA, June 2006. Preliminary study results have been reported in the form of a brief structured abstract in the Health Policy Newsletter 2007; 20(1): 4.
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Impact of ALLHAT publication on antihypertensive prescribing patterns in Regione Emilia-Romagna, Italy
Article first published online: 1 JUL 2009
DOI: 10.1111/j.1365-2710.2009.01047.x
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
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How to Cite
Maio, V. and Gagne, J. J. (2010), Impact of ALLHAT publication on antihypertensive prescribing patterns in Regione Emilia-Romagna, Italy. Journal of Clinical Pharmacy and Therapeutics, 35: 55–61. doi: 10.1111/j.1365-2710.2009.01047.x
Publication History
- Issue published online: 6 JAN 2010
- Article first published online: 1 JUL 2009
- Received 27 October 2008, Accepted 21 January 2009
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Keywords:
- hypertension;
- pharmacoepidemiology;
- prescribing patterns;
- thiazide diuretic
Summary
Background and objective: Studies from the US and Canada observed changes in antihypertensive prescribing patterns in accordance with Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study findings immediately after the study’s publication, but little is known about the impact of ALLHAT in Italy. The objective of this study was to examine antihypertensive prescribing patterns in Regione Emilia-Romagna (RER), Italy, following the publication of the ALLHAT main results.
Methods: We conducted a time series analysis using automated pharmacy data of approximately 4 million RER residents between 1 January 2000 and 31 December 2003. We computed monthly relative percentages of prescriptions for all antihypertensive medications and separately for all new antihypertensives defined as no recorded antihypertensive use in the previous year. A stepwise auto-regressive forecasting model based on data prior to the ALLHAT publication was used to estimate predicted relative percentages for the 12 months following the ALLHAT publication. Observed and predicted values were compared.
Results and discussion: Use of thiazide-type diuretics showed a general increasing trend over the study period, but the difference between the observed and predicted values reached statistical significance only for new prescriptions in October 2003 (3·71% vs. 2·32%; P = 0·0170). The relative percentage of new angiotensin-converting enzyme inhibitor and angiotensin receptor blocker (ACE/ARB) prescriptions was higher than predicted for the months May to August 2003 (P < 0·05), but no significant differences were observed for total ACE/ARB prescriptions. Modest changes in patterns of prescribing of calcium channel blockers and α-blockers were observed.
Conclusion: We found little evidence that the ALLHAT study had an impact on antihypertensive prescribing patterns in RER in the year following their publication.