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Prescription status of diuretics for essential hypertension in a Japanese population

Hypertension Research volume 44, pages 1359–1361 (2021)Cite this article

The Japanese Society of Hypertension (JSH) guidelines of 2019 recommend low-dose diuretics as a first-line treatment for hypertension [1]. The package inserts of diuretics in Japan list the dosage of diuretics in the clinical trial stage; however, it is common for the prescribed dosage to be more than double the dosage recommended by the JSH2019. Murai et al. reported the discrepancy between the actual clinical doses of diuretics and the doses recommended in the package inserts in 2003 [2]. Since then, the JSH has revised its guidelines on multiple occasions. However, it is not clear to what extent the dosage of diuretics for patients with hypertension has deviated from the dosages in the package inserts in recent years. The purpose of this study was to clarify the prescription status of diuretics for patients with essential hypertension based on medical data. This study may help clinicians determine treatment strategies in the future.

This study was conducted using the MDV analyzer (Medical Data Vision Co., Ltd., Tokyo, Japan) [3]. The MDV analyzer contains a deidentified hospital administrative database assembled by Medical Data Vision Co., Ltd. It contains medical information from patients at Japanese hospitals. In this study, a patient with essential hypertension was defined as any patient assigned an International Statistical Classification of Diseases 10th Revision (ICD-10) code for essential hypertension (I10 in ICD-10). This study population consisted of patients aged 18 years and older with essential hypertension. Data were collected from 417 hospitals between May 5, 2019, and April 30, 2020. This end date was selected because it marked one year since the publication of the JSH2019 guidelines. The targeted oral diuretics are listed in Table 1. This study considered both single and combination tablets containing these diuretics. The average daily doses of diuretics based on the MDV analyzer were compared with the doses recommended in the package insert and the JSH2019 guidelines. As we could not retrieve raw patient data from the MDV analyzer, the average daily dose of diuretics was calculated from the available data using the following formula:

$${\mathrm{Average}}\,{\mathrm{daily}}\,{\mathrm{dose}}\,{\mathrm{of}}\,{\mathrm{diuretics}} = \frac{{{\mathrm{Total}}\,{\mathrm{prescription}}\,{\mathrm{volume}} \times {\mathrm{standard}}\,{\mathrm{units}}}}{{{\mathrm{Total}}\,{\mathrm{prescription}}\,{\mathrm{days}}}}$$
Table 1 Targeted oral diuretic
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References

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Acknowledgements

Taku Obara received a Grant-in-Aid for Scientific Research (19K07213) from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

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Authors and Affiliations

  1. Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, Japan

    Daisuke Kikuchi, Misato Ito, Misaki Tokunaga, Kota Sasaki, Ryosuke Miura, Hiroyuki Hirakawa, Yuko Saito & Yoshiteru Watanabe

  2. Department of Molecular Epidemiology, Tohoku University Graduate School of Medicine 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan

    Taku Obara

  3. Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan

    Taku Obara

  4. Department of Pharmaceutical Sciences, Tohoku University Hospital 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan

    Taku Obara

  5. Tohoku Medical and Pharmaceutical University 4-4-1, Komatsushima, Aobaku, Sendai, Miyagi, Japan

    Yoshiteru Watanabe

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  1. Daisuke Kikuchi
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Correspondence to Taku Obara.

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Ethics

The authors declare no competing interest.The Institutional Review Boards of Tohoku Medical and Pharmaceutical University Hospital approved the present study (approval number: 2020-2-198). Because of the retrospective nature of this study, the requirement for informed consent was waived, and all personal data were anonymized.

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Kikuchi, D., Ito, M., Tokunaga, M. et al. Prescription status of diuretics for essential hypertension in a Japanese population. Hypertens Res 44, 1359–1361 (2021). https://doi.org/10.1038/s41440-021-00688-0

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