USE OF ANTIDIABETIC AND ANTIHYPERTENSIVE DRUGS IN-HOSPITAL AND OUTPATIENT SETTINGS IN HONG-KONG

OBJECTIVE: TO investigate the usage patterns of antidiabetic and antih ypertensive drugs and to identify any discordance between recommended management guidelines and clinical practice in two study locations. DE SIGN: Prescription survey. SETTING: A government-operated general outp atient clinic (GOPC) and a medical/geriatric specialist clinic (SC) af filiated with a regional hospital in the same district. PATIENTS: Pati ents presenting with a prescription during the study period at the res pective pharmacy were classified as having diabetes if at least one an tidiabetic agent was prescribed and as having hypertension if a cardio vascular drug was prescribed in a hypotensive dosage. MAIN OUTCOME MEA SURE: The pattern of use of antidiabetic and antihypertensive drugs. R ESULTS: One thousand one hundred forty-four consecutive prescriptions were collected in the GOPC, and 1523 in the SC. Of these, 9.4% (n = 10 7) of patients were classified as having diabetes in the GOPC and 20.4 % (n = 310) in the SC (p < 0.001). Most patients with diabetes were ta king oral hypoglycemic agents (98.1% in GOPC vs. 84.5% in SC). Glibenc lamide was the sulfonylurea used most often as monotherapy in both set tings (50.5% in GOPC vs. 40.6% in SC). The combined use of a sulfonylu rea with metformin was common in both settings (22.4% in GOPC vs. 28.4 % in SC), Metformin monotherapy (1.9% in GOPC vs. 2.6% in SC) and comb ination treatment of insulin with an oral agent (0% in GOPC vs. 2.6% i n SC) were rarely prescribed. In the GOPC, 24.5% (n = 280) of patients were prescribed an antihypertensive drug compared with 47.1% (n = 717 ) in the SC (p < 0.001). In the GOPC, the use of antihypertensive drug s was more prevalent in those with diabetes (53.5%) than in the remain ing patients without diabetes (21.5%, p < 0.001). In the SC, 51% of pa tients with diabetes were receiving antihypertensive drugs, but 40% of patients without diabetes were also receiving three treatments. In th e GOPC, diuretics (indapamide 14.3%, other 59%) and methyldopa (9.5%) were the most frequent choices of antihypertensive drugs when used as monotherapy in subjects without diabetes. In the SC, apart from diuret ics (indapamide 12.9%, other 20.3%), beta-blockers (29%) also were pre scribed frequently. If treated with only one antihypertensive drug, mo st patients with diabetes in the GOPC were prescribed indapamide (72.7 %), and patients in the SC were treated mainly with angiotensin-conver ting enzyme inhibitors (35%), indapamide (22.5%), or calcium-channel b lockers (13.8%). CONCLUSIONS: In this prescription-based survey, diabe tes mellitus and hypertension were found to be common diseases in gene ral practice and in a hospital SC. Oral hypoglycemic agents were the m ain form of antidiabetic therapy in both settings, with glibenclamide being the most commonly prescribed sulfonylurea. The types of antihype rtensive drugs used were different in the two locations and varied acc ording to the coexistence of type II diabetes mellitus. Despite some p otential limitations, prescription-based surveys are an easy and econo mical method for surveying the occurrence of some Common medical probl ems and the patterns of drug use in a fairly large number of patients in health institutions.