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

Tiantian Zhou^1,2Xing Liao³Jiaxin Zuo^1,2Fang Han¹Ruogu Meng⁴Zhuo Lin⁵Guozhen Liu⁶Jing Hu^1,2*

• ¹Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing, China
• ²Beijing Evidence-based Chinese Medicine Center, Beijing, China
• ³Center for Evidence-based Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
• ⁴National Institute of Health Data Science, Peking University, Beijing, Beijing Municipality, China
• ⁵Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, Beijing, China
• ⁶Beijing PD Cloud medical Technology Co., LTD, Beijing, China

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 covering 87 enterprise-led Internet hospitals in China from January 1, 2018, to March 31, 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 2 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%).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.