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

Discussion and Limitations

Compared with other ARB products, our findings indicate that the higher DACON score for losartan results in disproportionate costs to health care insurers. This becomes most evident when the proportion of ARBs dispensed based on the number of pills is compared with the proportion of annualized average wholesale price of each ARB based on a DACON score in excess of 1.0 ( Table 2 ). Although valsartan, including the combination with hydrochlorothiazide, was dispensed more frequently than losartan and its combinations (42% vs 31%, respectively), losartan accounted for a higher proportion of total annualized cost based on a DACON score in excess of 1.0.

Regardless of the product prescribed, physicians should treat all patients so that the therapeutic goal—as defined by the recent Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure—is achieved.[1] However, it is well established that patient compliance decreases as the prescribed number of daily doses in a given drug regimen increases.[2,3] In a review of antihypertensive medication studies, the compliance rate was shown to decrease by 8.2% when a drug was given more than once daily.[4] Therefore, physicians should select an antihypertensive medication that offers 24-hour control of blood pressure with a single daily dose. While our study did not assess patient compliance, one can infer from the literature that the more than once-daily use that is required of some ARB agents may have a negative impact on adherence to prescribed regimens, which may translate into poorer health outcomes.

Because of inherent limitations with retrospective claims data, we were unable to determine the effects that variations in prescribing patterns may have on members' health. The next logical step would be a medical-record audit of a sample of the members included in this study to ascertain whether the differences in dosages affect indicators of health status, such as blood pressure, medical resource utilization, and clinical outcomes.


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