{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:35:53Z","timestamp":1792697753478,"version":"4.5.0"},"reference-count":77,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FDN-143328"],"award-info":[{"award-number":["FDN-143328"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the prescribing trends of antihypertensive drugs in primary care patients and assess the trajectory of antihypertensive drug prescriptions, from first-line to third-line, in patients with hypertension according to changes to the United Kingdom (UK) hypertension management guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>We used the UK Clinical Practice Research Datalink, an electronic primary care database representative of the UK population. Between 1988 and 2018, we identified all adult patients with at least one prescription for a thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, beta-blocker or calcium channel blocker (CCB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We estimated the period prevalence of patients with antihypertensive drug prescriptions for each calendar year over a 31-year period. Treatment trajectory was assessed by identifying patients with hypertension newly initiating an antihypertensive drug, and treatment changes were defined by a switch or add-on of a new class. This cohort was stratified before and after 2007, the year following important changes to UK hypertension management guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 2 709 241 patients. The prevalence of primary care patients with antihypertensive drug prescriptions increased from 7.8% (1988) to 21.9% (2018) and was observed for all major classes except thiazide diuretics. Patients with hypertension initiated thiazide diuretics (36.8%) and beta-blockers (23.6%) as first-line drugs before 2007, and ACE inhibitors (39.9%) and CCBs (31.8%) after 2007. After 2007, 17.3% were not prescribed guideline-recommended first-line agents. Overall, patients were prescribed a median of 2 classes (IQR 1\u20132) after first-line treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly one-quarter of primary care patients were prescribed antihypertensive drugs by the end of the study period. Most patients with hypertension initiated guideline-recommended first-line agents. Not all patients, particularly females, were prescribed recommended agents however, potentially leading to suboptimal cardiovascular outcomes. Future research should aim to better understand the implication of this finding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-057510","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T12:44:06Z","timestamp":1654865046000},"page":"e057510","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3882-0998","authenticated-orcid":false,"given":"Julie","family":"Rouette","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily G.","family":"McDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Schuster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8049-6875","authenticated-orcid":false,"given":"James M.","family":"Brophy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5162-3556","authenticated-orcid":false,"given":"Laurent","family":"Azoulay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,10]]},"reference":[{"key":"2022061009402159000_12.6.e057510.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.13766"},{"key":"2022061009402159000_12.6.e057510.2","doi-asserted-by":"crossref","first-page":"963","DOI":"10.2147\/CLEP.S265966","article-title":"Comprehensive trends and patterns of antihypertensive prescriptions using a nationwide claims database in Korea","volume":"12","author":"Jung","year":"2020","journal-title":"Clin Epidemiol"},{"key":"2022061009402159000_12.6.e057510.3","unstructured":"Health survey for England 2016: prescribed medicines (2017)."},{"key":"2022061009402159000_12.6.e057510.4","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1016\/j.amjcard.2017.08.042","article-title":"Seventeen-Year nationwide trends in antihypertensive drug use in Denmark","volume":"120","author":"Sundb\u00f8ll","year":"2017","journal-title":"Am J Cardiol"},{"key":"2022061009402159000_12.6.e057510.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0200606","article-title":"Antihypertensive treatment and blood pressure trends among South African adults: a repeated cross-sectional analysis of a population panel survey","volume":"13","author":"Cois","year":"2018","journal-title":"PLoS One"},{"key":"2022061009402159000_12.6.e057510.6","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.0406","article-title":"Prevalence of hypertension, treatment, and blood pressure targets in Canada associated with the 2017 American College of cardiology and American heart association blood pressure guidelines","volume":"2","author":"Garies","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2022061009402159000_12.6.e057510.7","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/j.1524-4733.2008.00423.x","article-title":"Prescribing trends and drug budget impact of the Arbs in the UK","volume":"12","author":"Blak","year":"2009","journal-title":"Value Health"},{"key":"2022061009402159000_12.6.e057510.8","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014742","article-title":"Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta-Analysis","volume":"9","author":"Zhao","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2022061009402159000_12.6.e057510.9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.096156"},{"key":"2022061009402159000_12.6.e057510.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.298.6675.694"},{"key":"2022061009402159000_12.6.e057510.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.306.6883.983"},{"key":"2022061009402159000_12.6.e057510.12","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1000917"},{"key":"2022061009402159000_12.6.e057510.13","unstructured":"National Institute for Clinical Excellence . 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