A Retrospective Database Analysis of Prescribing Patterns for Specific Angiotensin Receptor Blockers

Saira A. Jan, MS, PharmD; Jay V. Patel, PharmD; John Welz, MPH; Patricia Ishak, PharmD

In This Article


A total of 13,391 members met the inclusion criteria and generated 82,640 pharmacy claims for ARB products during the study period. Members between the ages of 45 and 64 years accounted for nearly two thirds (65.6%) of the study sample, and men slighty outnumbered women (53.6% vs 46.6%). Overall, valsartan was the most frequently prescribed ARB, with 10,975 total prescriptions, followed by losartan, for which there were 9224 claims. ARBs were more likely to be prescribed alone than in combination with hydrochlorothi azide. The ratio of ARB to ARB-plus-hydrochlorothiazide prescriptions was 1.57:1.0.

Persons for whom losartan was prescribed were significantly more likely than were other ARB users to take the drug more than once a day (Figure 1). The dose frequency of losartan was more than once daily for 13.5% of patients, compared with 6.3% for eprosartan, 5.3% for irbesartan (Avapro), and 5.1% for valsartan. Among persons who took an ARB in combination with hydrochlorothiazide, less variation was evident. More than once-daily use was reported by 7.6% of losartan-plus-hydrochlorothiazide (Hyzaar) users, 5.5% of valsartan-plus-hydrochlorothiazide (Diovan HCT) users, and 4.2% of irbesartan-plus-hydrochlorothiazide (Avalide) users.

All ARBs, alone or in combination with HCT, were dosed more than once daily in some patients, with losartan and losartan plus HCT being the most common ARBs taken more than once daily. (ARBs, angiotensin II receptor blockers; HCT, hydrochlorothiazide.)

Variation in DACON among the ARB and ARB-plus-hydrochlorothiazide agents is shown in Figure 2. Losartan users were more likely to take the medication more than once daily, as evidenced by a DACON score of 1.14. This compares with DACON scores of only 1.06 for eprosartan, irbesartan, and valsartan ( P < .0001). Variation in DACON was not as great for users of ARB-plus-hydrochlorothiazide products.

Telmisartan is the ARB that is least likely to be used more than once daily. (ARB, angiotensin II receptor blocker; DACON, daily average consumption; HCT, hydrochlorothiazide.)

The DACON scores for valsartan and irbesartan increased only slightly in high-risk patients—patients with a diagnosis of both diabetes and hypertension—whereas the DACON scores for losartan and losartan-plus-hydrochlorothiazide were higher in patients who had both diabetes and hypertension than in patients who had hypertension alone (Figure 3). DACON scores indicate that in these high-risk patients, cost and compliance are optimal with valsartan and irbesartan. The difference in DACON scores between losartan and irbesartan in patients who had both diabetes and hypertension was statistically significant ( P < .0001), as was the difference between losartan and valsartan ( P = .0003).

For high-risk patients–patients with hypertension and diabetes–losartan and losartan plus HCT are the most likely agents to be used more than once daily. Compared with the overall study population, persons in this subpopulation are more likely to take ARBs more than once daily. (DACON, daily average consumption; ARBs, angiotensin II receptor blockers; HCT, hydrochlorothiazide.)

A cost analysis was conducted to assess the potential impact of using an ARB with a higher DACON score on pharmacy costs ( Table 2 ). At a DACON of 1.14, a 30-day supply of losartan would consist of 34.2 tablets, compared with 31.8 tablets for irbesartan, valsartan, or eprosartan, the next highest comparators, each with a DACON of 1.06. Using a weighted average wholesale price of $1.69 per tablet for losartan, this 2.4-tablet difference results in an incremental $4.05 for each 30-day supply of losartan.


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