Prescribing characteristics and guideline concordance of antihypertensive western and Chinese patent medicine in Internet hospitals in China: a cross-sectional study

Abstract

Introduction: Internet hospitals have emerged as a vital approach for patients seeking treatment for hypertension, with a significant increase in antihypertensive medication prescriptions through these innovative models. However, prescribing characteristics and guideline concordance of these prescriptions remain unclear. This study aim to analyze the prescribing characteristics of Western medicine (WM) and Chinese patent medicine (CPM) for hypertension and assess their concordance with hypertension guidelines in Internet hospitals in China, providing insights for optimizing antihypertensive CPM management.

Methods: A cross-sectional analysis was conducted using data from the Yinchuan Internet Medical Regulatory Platform (YIMRP) covering 87 enterprise-led Internet hospitals in China from 1 January 2018, to 31 March 2021. Visits diagnosed with hypertension and prescribed at least one oral antihypertensive medication (either WM or CPM) were included. Guideline concordance was evaluated by comparing prescribed individual antihypertensive WM and CPM in Internet hospitals with international and Chinese hypertension guidelines recommendations. Statistical analyses included descriptive statistics, association rule analysis, and guideline concordance assessment.

Results: Among the 787,209 visits, 93.75% were prescribed WM alone, 4.72% CPM alone, and 1.52% a combination of CPM and WM. Calcium channel blockers (CCBs) (38.50%) was the most prescribed WM class, with nifedipine (19.67%) being the most common individual medication. Most prescriptions of antihypertensive WM were guideline-concordant. Among CPM prescriptions, only 181 (0.37%) included traditional Chinese medicine (TCM) syndrome diagnoses. Of the 38 prescribed antihypertensive CPM, only 7 were guideline-recommended. The most frequently prescribed CPM were Jiuqiang Naoliqing (17.67%), and Zhenju Jiangya tablet (14.74%), neither of which was recommended by the guidelines. The combinations of two CPM were frequently prescribed, but none of these combinations were recommended by guidelines. The most common dual CPM combination was Jiuqiang Naoliqing + Qiangli Dingxuan tablet/capsule (support 8.65%, confidence 0.44%).

Conclusion: The prescribing characteristics of antihypertensive WM in Internet hospitals closely align with those in offline hospitals with relatively satisfactory guideline concordance. However, some issues persist in antihypertensive CPM prescriptions, including the lack of TCM syndrome differentiation, frequent prescription of non-recommended CPM, and duplicate therapies. Strengthening CPM management in Internet hospitals is essential for optimizing hypertension care.

Keywords: Chinese patent medicine; Internet hospitals; Western medicine; guidelines concordance; hypertension; prescribing characteristics.

FIGURE 1

Flow chart of screening eligible visits.

FIGURE 2

Individual and classes of all antihypertensive WM. Note: ACEIs, angiotensin-converting enzyme inhibitors; ARNI, angiotensin receptor-neprilysin inhibitor; ARBs, angiotensin receptor blockers; CCBs, calcium channel blockers; SPCs, single-pill combinations; WM with a frequency less than 0.5% in a category are grouped as “other”.

FIGURE 3

Association rule diagram of antihypertensive WM combinations. Note: Weak links ≤15 and strong links ≥35. The stronger line showed more frequent co-prescribed between medicine.

FIGURE 4

Categories of antihypertensive CPM and the top 10 most common CPM. Note: JQNLQ, Jiuqiang Naoliqing; ZJJYT, Zhenju Jiangya tablet; QLDXT, Qiangli Dingxuan tablet/capsule; QNJYT, Qingnao Jiangya tablet; NHJYP, Niuhuang Jiangya tablet/pill; LBMJYT, Luobuma Jiangya tablet; ZNNC, Zhennaoning capsule/granule; DZPYT, Duzhong Pinya tablet; SJJYC, ShanJu Jiangya capsule; ESWWSHP, Ershiwuwei Shanhu pill.

FIGURE 5

Association rule diagram of antihypertensive CPM and WM. Note: JQNLQ, Jiuqiang Naoliqing; ZJJYT, Zhenju Jiangya tablet; QLDXT, Qiangli Dingxuan tablet/capsule; QNJYT, Qingnao Jiangya tablet; NHJYP, Niuhuang Jiangya tablet/pill; LBMJYT, Luobuma Jiangya tablet; ZNNC, Zhennaoning capsule/granule; DZPYT, Duzhong Pinya tablet; SJJYC, ShanJu Jiangya capsule; ESWWSHP, Ershiwuwei Shanhu pill.