Characterization of pharmacoepidemiology, adverse outcomes and efficacy of the major classes of antihypertensive drugs commonly used in primary care settings in Hong Kong

In these studies we have characterized the major antihypertensive drug classes in terms of their prescription patterns, efficacy, tolerability and association with adverse clinical as well as biochemical outcomes. The completeness of CDARS and e-CMS of the Hospital Authority allows retrieval and comparison of these clinical outcomes of the commonly used antihypertensive agents. The present studies showed that prescription of CCB and BB were high compared with international trends and that of thiazide particularly low and showed a declining trend. Yet when compared with other drug classes, thiazide diuretics: (1) Were among the antihypertensive drugs with the lowest likelihood of discontinuation implying a potentially superior tolerability profile. (2) Had similar odds of short and long term rates of add-on pharmacotherapy implying a similar efficacy with other drug classes. (3) Were associated with statistically similar all cause and CVS mortality. (4) Had similar odds of presenting with impaired fasting glucose in the short-term. (5) Had higher odds of presenting with hypercholesterolemia in the short-term but the absolute increase in cholesterol was minimal (in the magnitude of 0.14 mmol/1). (6) Had similar odds of presenting with hyponatremia and hypokalemia in the short-term.;Due to the large sample size these studies are likely to be representative and are new findings among ethnic Chinese patients presenting with uncomplicated hypertension. These results point towards thiazide diuretics as a favorable first-line antihypertensive agent in the management of uncomplicated hypertension in Hong Kong primary practice, in addition to favorable public health considerations including affordability. These studies are in support of guidelines from international authorities recommending thaizide diuretics as the best choice of first-line antihypertensive agent, and suggest that such international guidelines may be generalizable to patients of Chinese race.