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Trends in antihypertensive prescription for pregnant women with hypertension and their peripartum outcomes before and after label and guideline revisions in Japan.
Hypertens Res. 2022 11; 45(11):1823-1831.HR

Abstract

We investigated the trends in the proportion of antihypertensive prescriptions listed in the guidelines for pregnant patients and their pregnancy outcomes before and after regulatory actions in Japan. This retrospective cohort study used the Japan Medical Data Center claims data from January 2005 to April 2020. We identified women who had delivered and had hypertensive disorders before childbirth. To evaluate the influence of regulatory actions (label revision in 2011 and guideline updates in 2014), we divided the study period into three terms based on the year of the last menstrual period. We assessed the time trend of the prescription proportion of antihypertensives and conducted multivariable logistic regression analyses to assess the impact of the investigation terms on pregnancy outcomes (preterm birth, cesarean section, emergency cesarean section, and Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome). Among the 13,797 eligible patients, 1739 (12.6%) were treated with oral antihypertensives during pregnancy. Before the policy revisions, the most frequently prescribed antihypertensive medication was methyldopa, but after the label and guideline revisions, nifedipine was the most frequently prescribed. The trend in the prescription proportion of nifedipine increased (P < 0.001) and that of hydralazine decreased (P < 0.001), while those of methyldopa and labetalol showed no significant trend. The adjusted odds ratios for all four pregnancy outcomes showed no significant differences according to the investigation terms. By investigating the three terms before and after the label and guideline revisions, significant changes were identified in the trend of the prescription proportion for pregnant women-an increase in nifedipine and a decrease in hydralazine-but not in pregnancy outcomes.

Authors+Show Affiliations

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. reina-taguchi@umin.ac.jp.Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36109600

Citation

Taguchi, Reina, et al. "Trends in Antihypertensive Prescription for Pregnant Women With Hypertension and Their Peripartum Outcomes Before and After Label and Guideline Revisions in Japan." Hypertension Research : Official Journal of the Japanese Society of Hypertension, vol. 45, no. 11, 2022, pp. 1823-1831.
Taguchi R, Shigemi D, Yasunaga H. Trends in antihypertensive prescription for pregnant women with hypertension and their peripartum outcomes before and after label and guideline revisions in Japan. Hypertens Res. 2022;45(11):1823-1831.
Taguchi, R., Shigemi, D., & Yasunaga, H. (2022). Trends in antihypertensive prescription for pregnant women with hypertension and their peripartum outcomes before and after label and guideline revisions in Japan. Hypertension Research : Official Journal of the Japanese Society of Hypertension, 45(11), 1823-1831. https://doi.org/10.1038/s41440-022-01018-8
Taguchi R, Shigemi D, Yasunaga H. Trends in Antihypertensive Prescription for Pregnant Women With Hypertension and Their Peripartum Outcomes Before and After Label and Guideline Revisions in Japan. Hypertens Res. 2022;45(11):1823-1831. PubMed PMID: 36109600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in antihypertensive prescription for pregnant women with hypertension and their peripartum outcomes before and after label and guideline revisions in Japan. AU - Taguchi,Reina, AU - Shigemi,Daisuke, AU - Yasunaga,Hideo, Y1 - 2022/09/15/ PY - 2022/04/17/received PY - 2022/08/13/accepted PY - 2022/07/20/revised PY - 2022/9/16/pubmed PY - 2022/11/9/medline PY - 2022/9/15/entrez KW - Antihypertensives KW - Claims database KW - Hypertensive disorders of pregnancy KW - Regulatory action SP - 1823 EP - 1831 JF - Hypertension research : official journal of the Japanese Society of Hypertension JO - Hypertens Res VL - 45 IS - 11 N2 - We investigated the trends in the proportion of antihypertensive prescriptions listed in the guidelines for pregnant patients and their pregnancy outcomes before and after regulatory actions in Japan. This retrospective cohort study used the Japan Medical Data Center claims data from January 2005 to April 2020. We identified women who had delivered and had hypertensive disorders before childbirth. To evaluate the influence of regulatory actions (label revision in 2011 and guideline updates in 2014), we divided the study period into three terms based on the year of the last menstrual period. We assessed the time trend of the prescription proportion of antihypertensives and conducted multivariable logistic regression analyses to assess the impact of the investigation terms on pregnancy outcomes (preterm birth, cesarean section, emergency cesarean section, and Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome). Among the 13,797 eligible patients, 1739 (12.6%) were treated with oral antihypertensives during pregnancy. Before the policy revisions, the most frequently prescribed antihypertensive medication was methyldopa, but after the label and guideline revisions, nifedipine was the most frequently prescribed. The trend in the prescription proportion of nifedipine increased (P < 0.001) and that of hydralazine decreased (P < 0.001), while those of methyldopa and labetalol showed no significant trend. The adjusted odds ratios for all four pregnancy outcomes showed no significant differences according to the investigation terms. By investigating the three terms before and after the label and guideline revisions, significant changes were identified in the trend of the prescription proportion for pregnant women-an increase in nifedipine and a decrease in hydralazine-but not in pregnancy outcomes. SN - 1348-4214 UR - https://www.unboundmedicine.com/medline/citation/36109600/Trends_in_antihypertensive_prescription_for_pregnant_women_with_hypertension_and_their_peripartum_outcomes_before_and_after_label_and_guideline_revisions_in_Japan. DB - PRIME DP - Unbound Medicine ER -