Hospital size tied to more intensive hypertension therapy

Larger medical facilities receive more difficult-to-treat cases of hypertension and tend to prescribe a higher number of antihypertensive drugs, a recent Japan study has found.

Drawing from the health insurance claims database of Japan, the researchers examined 805,439 claims, of which 46,690 included at least one antihypertensive drug prescribed for ≥28 days. Claims were also divided into four according to the issuing facility: large (≥200 beds), medium (100–200 beds), and small (20–100 beds) hospitals, and clinics (0–20 beds).

The primary outcome of the study was the number of antihypertensive drugs in each insurance claim, compared across the facility sizes. The proportion of patients presenting with difficult-to-treat hypertension—those who were prescribed ≥3 classes of antihypertensive medication—was also compared across groups.

Approximately 80 percent (n=34,734) of hypertension patients were followed-up in clinics; only 3,445 claims were deemed to come from large hospitals, while 1,797 and 2,323 were from medium and small hospitals, respectively.

Despite seeing the greatest number of patients, small clinics prescribed the lowest average number of hypertension medication per patient, at 1.69, while large hospitals had the highest, at 1.96. Small and medium hospitals prescribed an average of 1.81 and 1.87 medications per patient, respectively.

Following the same trend, large hospitals saw the highest proportion of difficult-to-treat hypertension patients (18.9 percent), followed by medium-sized facilities (17.0 percent). Small hospitals (14.3 percent) and clinics (12.0 percent) had the lowest proportion of patients needing ≥3 classes of antihypertensive drugs.