Objective: Evaluate the impact of antihypertensive drugs (AHD) on stroke and acute myocardial infarction (AMI) and death
for 3 cohorts of patients: diabetics, high risk, and hypertensive. Methods: This
was a retrospective cohort obervational study based on administrative database
of 7 Italian Local Health Units. Newly treated patients with AHD were enrolled
from 01/01/2004 to 06/30/2007. Drug
utilization and incidence of death, stroke and AMI were measured until
12/31/2007. Results: The study enrolled 125,770
patients aged ≥ 18-year-old: 8516 diabetic, 8549 high risk, and 108,705 hypertensive. Diabetic and high risk patients were more frequently male (57.2%, 64.9% VS 46.6%) and older (66.4 ± 11.6,
67.5 ± 13.2 VS 61.6 ± 13.9) than hypertensive patients and were more treated
with concomitant therapy. Drugs acting on the renin-angiotensin system were the
more fre- quent choice in the three cohorts but with a dif- ferent prevalence
(63.9%, 52.9%, 35.9% in dia- betic, hypertensive and high risk patients re- spectively).
Adherent patients to AHD > 80% were 44.0% among diabetic patients, 48.4%
among high risk, 35.2% among hypertensive. A Cox regression model showed that
the risk of the combined outcome was
determined by increasing age, male gender, presence of concomitant
therapy, low adherence to AHD and first choice of AHD. Conclusions: An
integrated analysis of prescription and hospital admission database has the
great advantage that it uses routinely available data, it can be done quickly
and by few staff, and it is less expensive than planned large scale survey.