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Real-World Data, EHRs Can Analyze and Compare Treatment Practices


The increasing availability of EHRs allows researchers to compare results from trials to data from actual practice.


Electronic health records (EHRs) can be used to analyze and compare actual treatment practices of hypertension, according to a real-world data analysis conducted by TriNetX.

The efficacy of antihypertensive treatment is primarily assessed by randomized clinical trials. But the increasing availability of EHRs allows researchers to compare the results from the trials to data from actual clinical practice.

Manfred Paul Stapff, M.D., Ph.D., chief medical officer of TriNetX, and Sarah Hilderbrand, M.Sc., used a subset of EHR data from the TriNetX network of approximately 68 million patients in 56 large healthcare organizations to compare patients starting and adhering to one of four antihypertensive treatments — diuretics, beta blockers, angiotensin II or calcium channel blockers — for at least three years.

The analysis evaluated cardiovascular events and assessed outcomes with and without propensity score matching for confounding factors.

Stapff and Hilderbrand analyzed the EHRs of more than 5.7 million patients who had essential hypertension and their first recorded instance of any cardiovascular medication after Dec. 31, 2008.

More than 79,000 patients fulfilled the criteria for first-line therapy and adherence, with 17.4% on diuretics, 25.9% on beta blockers, 45.1% on renin-angiotensin system blockers and 11.6% on calcium channel blockers.

Patients in the group taking renin-angiotensin system blockers for at least three years had the largest blood pressure reduction and best blood pressure control. The patients in that group and those on diuretics had the lowest rate of predefined clinical outcomes within the three-year observation period, with 5.4% and 5.2% respectively.

The renin-angiotensin system blockers group also had the fewest documentations of uncontrolled hypertension (28.7%) Those in the beta blocker group had the highest percentage of cardiovascular events, with 45.9% having an event.

Patients on calcium channel blockers had the highest rates of cerebrovascular events and a slightly higher rate of newly documented chronic kidney disease.

The EHRs showed that actual prescribing behavior for first-line treatment of essential hypertension reflects treatment guidelines.

Randomized clinical trials are complex, lengthy and costly, according to Stapff and Hilderbrand. Data that are in the EHR directly from actual medical practice could better represent the real world — especially long-term outcomes.

Real-world data of prescribing patterns for first-line treatment of essential hypertension also correlate to treatment guidelines for patients with relevant characteristics.

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