Outpatient Hypertension Control and Prescribing Habits for Hypertension in Taiwan.

BACKGROUND: Hypertension control is of the utmost importance for reducing cardiovascular risk. In Taiwan, the hypertension control rate of the general population is low (25%). We investigated the factors affecting outpatient hypertension control to determine whether the low control rate stems from clinician unawareness or inadequate public education. METHODS: Hypertensive patients were recruited between 2003 and 2004 by 13 cardiologists and 9 non-cardiologists from 19 hospitals distributed across four geographical areas of Taiwan. Each clinician recruited 100 consecutive patients from outpatient clinics and reported their drug prescriptions, co-morbidities, and blood pressure (BP) levels. Data were analyzed using the chi square test and multivariate logistic regression analyses. RESULTS: Of the 2145 enrolled patients, 63% attained the BP goal of < 140/90 mmHg. BP control rates were higher in older patients, and in patients who were treated by cardiologists and at medical centers. The control rate of high risk co-morbidity patients (BP goal of < 130/80 mmHg) was 36%, which was significantly lower than the 62% control rate of low risk patients (BP goal of < 140/90 mmHg). Cardiologists achieved higher BP control rates (65% vs. 60%; p = 0.0039), and prescribed more combination regimens (p < 0.0001) and beta blockers than non-cardiologists. Overall, 63% of patients received combination therapy. Calcium channel blockers were the most commonly prescribed antihypertensive drugs, followed by beta blockers, angiotensin receptor blockers, diuretics, and angiotensin-converting enzyme inhibitors. CONCLUSIONS: Two-thirds of the entire study population received combination therapy, although BP control rate is still less than optimal in the high risk patients. Ultimately, a more aggressive strategy is strongly encouraged for patients considered to be at high risk. KEY WORDS: Combination therapy; Hypertension control rate; Prescribing habit.

Prevalence of hyperuricemia and its association with antihypertensive treatment in hypertensive patients in Taiwan.

BACKGROUND: Hyperuricemia is thought to be associated with an increased risk of hypertension, impaired renal function and cardiovascular disease. Our aim is to study the prevalence of hyperuricemia and its association with antihypertensive treatment in Taiwanese hypertensive subjects. METHODS: We recruited 2145 hypertensive subjects from 19 hospitals in four areas of Taiwan. We assessed the prevalence of hyperuricemia and determined the independent risk factors for raised serum uric acid level by multiple logistic regression analyses. RESULTS: Compared to the general population, hypertensive subjects in Taiwan had a higher prevalence (mean 35% in males, 43% in females) of hyperuricemia; this prevalence being 1.5- and 1.7-fold higher in males and females respectively. Uric acid levels; gout and prevalence of hyperuricemia were found to be highest in the younger age group (20-39 years) and no regional differences were noted. The most important risk factors for hyperuricemia were impaired renal function and diuretic use. Serum uric acid values correlated significantly with four quintiles of serum creatinine (p<0.0001) independent of diuretic use. Diuretic users had a significantly elevated serum uric acid and serum creatinine values than non-users. Among the patients given diuretics, hyperuricemia occurred in 44% of those given thiazides, in 56% of those given loop diuretics, and in 57% of those given aldosterone receptor blockers. CONCLUSIONS: Diuretic usage and renal function status have a strong impact on the prevalence of hyperuricemia in Taiwanese hypertensive subjects. It is still unclear, however, whether diuretics induce renal failure through elevating serum uric acid levels.

A multicenter study of the association of serum uric acid, serum creatinine, and diuretic use in hypertensive patients.

BACKGROUND: Individuals with hypertension and hyperuricemia have an increased risk of coronary artery disease and cerebral vascular disease as compared to patients with normal uric acid levels. Our aim is to determine the prevalence of hyperuricemia in hypertensive patients in Taiwan, and whether serum uric acid (SUA) is associated with changes in renal function in patients with hypertension. METHODS: We studied 2145 hypertensive patients receiving medical treatment, assessed the prevalence of hyperuricemia, and determined the independent risk factors for SUA. Simple correlation and multiple regression analyses were applied to identify the independent risk factors for SUA increase. Logistic regression analysis was used to estimate the association between 4 quartiles of SUA level and correspondent serum creatinine (SCr) concentrations. RESULTS: Hypertensive subjects had a high prevalence of hyperuricemia (men, 35%; women, 43%). SUA was significantly associated with the independent risk factors of SCr, diuretic usage, and diabetes (inversely related) in both genders, whereas ß-blocker usage and body mass index were only associated in men. Multiple logistic regression models showed that in the non-diuretic user group the highest SUA quartile entailed >4 times greater risk for SCr elevation than the lowest. In the diuretic user group, a >2 times greater risk was noted. CONCLUSIONS: Hyperuricemia hypertensive subjects demonstrated a corresponding elevation of SUA and SCr irrespective of diuretic use. Elevation of SUA, in addition to SCr, may represent a progression of renal function impairment.