Prescription Patterns of Angiotensin-Converting Enzyme Inhibitors for Various Indications: A UK Population-based Study

Abstract

AIM: Angiotensin-converting enzyme inhibitors (ACE-inhibitors) are widely prescribed for several cardiovascular indications. This study investigated patterns of ACE-inhibitor use for various indications. METHODS: A descriptive, retrospective population-based study was conducted using data from the UK Clinical Practice Research Datalink. Patients starting ACE-inhibitors (2007-2014) were selected and ACE-inhibitor indications were retrieved from electronically recorded medical records. Stratified by indication, we distinguished between persistent and non-persistent ACE-inhibitor use, considering a six-month interval between two prescription periods as a maximum for persistent use. Five-year persistence rates for various indications were calculated using the Kaplan-Meier method and compared in a log-rank test. Non-persistent users were subdivided into three groups: 1) stop, 2) restart, and 3) switch to an angiotensin II-receptor blocker (ARB). Patients who received ACE-inhibitors for hypertension who switched to other classes of antihypertensive medications were further investigated. RESULTS: In total, 254,002 ACE-inhibitor initiators were identified with hypertension (57.6%), myocardial infarction (MI) (4.2%), renal disease (RD) (3.7%), heart failure (HF) (1.5%), combinations of the above (17.2%), or none of the above (15.8%). Five-year persistence rates ranged from 43.2% (RD) to 68.2% (MI) (p<0.0001). RD and HF patients used ACE-inhibitors for the shortest time (average 23.6 and 25.0 months, respectively). For the non-persistent group, the percentage of switchers to ARBs ranged from 27.6% (RD) to 42.2% (MI) and the restarters ranged from 15.0% (HF) to 18.1% (group without indication). CONCLUSIONS: Depending on the indication, there are various rates of ACE-inhibitor non-persistence. Patients with RD are most likely to discontinue treatment.