Inhaled anticholinergic agent tiotropium is widely used in the treatment of chronic obstructive pulmonary disease（COPD）. However, it has pro-arrhythmic and pro-ischaemic effects, which can potentially increase the risk of serious cardiovascular events, especially in patients with pre-existing arrhythmias. We presented a 79-year-old man with a medical history of arrhythmia, who developed atrial fibrillation after used tiotropium 18 μg daily for two weeks. We urge the caution of pro-arrhythmic effect of tiotropium. Healthcare professionals should be aware of the potential effect when prescribing tiotropium to patients with known cardiac rhythm disorders.
This study aimed to investigate various regimens of antihypertensive agents for different groups of patients and the outcomes in the real world. We retrospectively collected 974 prescriptions for hypertension from three hospitals in Beijing, along with medical records of 219 hypertensive patients from one of the hospitals to study the regimens and their effects on patients. The antihypertensive regimens were classified by different combinations of subclasses of antihypertensive agents. Nearly all prescriptions can be classified into 11 different antihypertensive regimens, and most of them are combination therapy. Grade III hypertension patients significantly （P〈0.001） tend to be treated with regimens containing calcium channel blocker （CCB） and RAAS inhibitors, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI）. β-Blockers are more likely to be combined with CCB than with other categories of antihypertensive agents. Hydrochlorothiazide is less widely used than recommended.
