B Cohort definitions

This Appendix contains cohort definitions used throughout the book.

B.1 ACE inhibitors

Initial Event Cohort

People having any of the following:

  • a drug exposure of ACE inhibitors (Table B.1) for the first time in the person’s history

with continuous observation of at least 365 days prior and 0 days after event index date, and limit initial events to: all events per person.

Limit qualifying cohort to: all events per person.

End Date Strategy

Custom Drug Era Exit Criteria This strategy creates a drug era from the codes found in the specified concept set. If the index event is found within an era, the cohort end date will use the era’s end date. Otherwise, it will use the observation period end date that contains the index event.

Use the era end date of ACE inhibitors (Table B.1)

  • allowing 30 days between exposures
  • adding 0 days after exposure end

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 30 days.

Concept Set Definitions

Table B.1: ACE inhibitors
Concept Id Concept Name Excluded Descendants Mapped
1308216 Lisinopril NO YES NO
1310756 moexipril NO YES NO
1331235 quinapril NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1340128 Captopril NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1363749 Fosinopril NO YES NO
1373225 Perindopril NO YES NO

B.2 New users of ACE inhibitors monotherapy

Initial Event Cohort

People having any of the following:

  • a drug exposure of ACE inhibitors (Table B.2) for the first time in the person’s history

with continuous observation of at least 365 days prior and 0 days after event index date, and limit initial events to: earliest event per person.

Inclusion Rules

Inclusion Criteria #1: has hypertension diagnosis in 1 yr prior to treatment

Having all of the following criteria:

  • at least 1 occurrences of a condition occurrence of Hypertensive disorder (Table B.3) where event starts between 365 days Before and 0 days After index start date

Inclusion Criteria #2: Has no prior antihypertensive drug exposures in medical history

Having all of the following criteria:

  • exactly 0 occurrences of a drug exposure of Hypertension drugs (Table B.4) where event starts between all days Before and 1 days Before index start date

Inclusion Criteria #3: Is only taking ACE as monotherapy, with no concomitant combination treatments

Having all of the following criteria:

  • exactly 1 distinct occurrences of a drug era of Hypertension drugs (Table B.4) where event starts between 0 days Before and 7 days After index start date

Limit qualifying cohort to: earliest event per person.

End Date Strategy

Custom Drug Era Exit Criteria. This strategy creates a drug era from the codes found in the specified concept set. If the index event is found within an era, the cohort end date will use the era’s end date. Otherwise, it will use the observation period end date that contains the index event.

Use the era end date of ACE inhibitors (Table B.2)

  • allowing 30 days between exposures
  • adding 0 days after exposure end

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 0 days.

Concept Set Definitions

Table B.2: ACE inhibitors
Concept Id Concept Name Excluded Descendants Mapped
1308216 Lisinopril NO YES NO
1310756 moexipril NO YES NO
1331235 quinapril NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1340128 Captopril NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1363749 Fosinopril NO YES NO
1373225 Perindopril NO YES NO
Table B.3: Hypertensive disorder
Concept Id Concept Name Excluded Descendants Mapped
316866 Hypertensive disorder NO YES NO
Table B.4: Hypertension drugs
Concept Id Concept Name Excluded Descendants Mapped
904542 Triamterene NO YES NO
907013 Metolazone NO YES NO
932745 Bumetanide NO YES NO
942350 torsemide NO YES NO
956874 Furosemide NO YES NO
970250 Spironolactone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
991382 Amiloride NO YES NO
1305447 Methyldopa NO YES NO
1307046 Metoprolol NO YES NO
1307863 Verapamil NO YES NO
1308216 Lisinopril NO YES NO
1308842 valsartan NO YES NO
1309068 Minoxidil NO YES NO
1309799 eplerenone NO YES NO
1310756 moexipril NO YES NO
1313200 Nadolol NO YES NO
1314002 Atenolol NO YES NO
1314577 nebivolol NO YES NO
1317640 telmisartan NO YES NO
1317967 aliskiren NO YES NO
1318137 Nicardipine NO YES NO
1318853 Nifedipine NO YES NO
1319880 Nisoldipine NO YES NO
1319998 Acebutolol NO YES NO
1322081 Betaxolol NO YES NO
1326012 Isradipine NO YES NO
1327978 Penbutolol NO YES NO
1328165 Diltiazem NO YES NO
1331235 quinapril NO YES NO
1332418 Amlodipine NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1338005 Bisoprolol NO YES NO
1340128 Captopril NO YES NO
1341238 Terazosin NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1344965 Guanfacine NO YES NO
1345858 Pindolol NO YES NO
1346686 eprosartan NO YES NO
1346823 carvedilol NO YES NO
1347384 irbesartan NO YES NO
1350489 Prazosin NO YES NO
1351557 candesartan NO YES NO
1353766 Propranolol NO YES NO
1353776 Felodipine NO YES NO
1363053 Doxazosin NO YES NO
1363749 Fosinopril NO YES NO
1367500 Losartan NO YES NO
1373225 Perindopril NO YES NO
1373928 Hydralazine NO YES NO
1386957 Labetalol NO YES NO
1395058 Chlorthalidone NO YES NO
1398937 Clonidine NO YES NO
40226742 olmesartan NO YES NO
40235485 azilsartan NO YES NO

B.3 Acute myocardial infarction (AMI)

Initial Event Cohort

People having any of the following:

  • a condition occurrence of Acute myocardial Infarction (Table B.5)

with continuous observation of at least 0 days prior and 0 days after event index date, and limit initial events to: all events per person.

For people matching the Primary Events, include: Having any of the following criteria:

  • at least 1 occurrences of a visit occurrence of Inpatient or ER visit (Table B.6) where event starts between all days Before and 0 days After index start date and event ends between 0 days Before and all days After index start date

Limit cohort of initial events to: all events per person.

Limit qualifying cohort to: all events per person.

End Date Strategy

Date Offset Exit Criteria. This cohort defintion end date will be the index event’s start date plus 7 days

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 180 days.

Concept Set Definitions

Table B.5: Inpatient or ER visit
Concept Id Concept Name Excluded Descendants Mapped
314666 Old myocardial infarction YES YES NO
4329847 Myocardial infarction NO YES NO
Table B.6: Inpatient or ER visit
Concept Id Concept Name Excluded Descendants Mapped
262 Emergency Room and Inpatient Visit NO YES NO
9201 Inpatient Visit NO YES NO
9203 Emergency Room Visit NO YES NO

B.4 Angioedema

Initial Event Cohort

People having any of the following:

  • a condition occurrence of Angioedema (Table B.7)

with continuous observation of at least 0 days prior and 0 days after event index date, and limit initial events to: all events per person.

For people matching the Primary Events, include: Having any of the following criteria:

  • at least 1 occurrences of a visit occurrence of Inpatient or ER visit (Table B.8) where event starts between all days Before and 0 days After index start date and event ends between 0 days Before and all days After index start date

Limit cohort of initial events to: all events per person.

Limit qualifying cohort to: all events per person.

End Date Strategy

This cohort defintion end date will be the index event’s start date plus 7 days

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 30 days.

Concept Set Definitions

Table B.7: Angioedema
Concept Id Concept Name Excluded Descendants Mapped
432791 Angioedema NO YES NO
Table B.8: Inpatient or ER visit
Concept Id Concept Name Excluded Descendants Mapped
262 Emergency Room and Inpatient Visit NO YES NO
9201 Inpatient Visit NO YES NO
9203 Emergency Room Visit NO YES NO

B.5 New users of Thiazide-like diuretics monotherapy

Initial Event Cohort

People having any of the following:

  • a drug exposure of Thiazide or thiazide-like diuretic (Table B.9) for the first time in the person’s history

with continuous observation of at least 365 days prior and 0 days after event index date, and limit initial events to: earliest event per person.

Inclusion Rules

Inclusion Criteria #1: has hypertension diagnosis in 1 yr prior to treatment

Having all of the following criteria:

  • at least 1 occurrences of a condition occurrence of Hypertensive disorder (Table B.10) where event starts between 365 days Before and 0 days After index start date

Inclusion Criteria #2: Has no prior antihypertensive drug exposures in medical history

Having all of the following criteria:

  • exactly 0 occurrences of a drug exposure of Hypertension drugs (Table B.11) where event starts between all days Before and 1 days Before index start date

Inclusion Criteria #3: Is only taking ACE as monotherapy, with no concomitant combination treatments

Having all of the following criteria:

  • exactly 1 distinct occurrences of a drug era of Hypertension drugs (Table B.11) where event starts between 0 days Before and 7 days After index start date

Limit qualifying cohort to: earliest event per person.

End Date Strategy

Custom Drug Era Exit Criteria. This strategy creates a drug era from the codes found in the specified concept set. If the index event is found within an era, the cohort end date will use the era’s end date. Otherwise, it will use the observation period end date that contains the index event.

Use the era end date of Thiazide or thiazide-like diuretic (Table B.9)

  • allowing 30 days between exposures
  • adding 0 days after exposure end

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 0 days.

Concept Set Definitions

Table B.9: Thiazide or thiazide-like diuretic
Concept Id Concept Name Excluded Descendants Mapped
907013 Metolazone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
1395058 Chlorthalidone NO YES NO
Table B.10: Hypertensive disorder
Concept Id Concept Name Excluded Descendants Mapped
316866 Hypertensive disorder NO YES NO
Table B.11: Hypertension drugs
Concept Id Concept Name Excluded Descendants Mapped
904542 Triamterene NO YES NO
907013 Metolazone NO YES NO
932745 Bumetanide NO YES NO
942350 torsemide NO YES NO
956874 Furosemide NO YES NO
970250 Spironolactone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
991382 Amiloride NO YES NO
1305447 Methyldopa NO YES NO
1307046 Metoprolol NO YES NO
1307863 Verapamil NO YES NO
1308216 Lisinopril NO YES NO
1308842 valsartan NO YES NO
1309068 Minoxidil NO YES NO
1309799 eplerenone NO YES NO
1310756 moexipril NO YES NO
1313200 Nadolol NO YES NO
1314002 Atenolol NO YES NO
1314577 nebivolol NO YES NO
1317640 telmisartan NO YES NO
1317967 aliskiren NO YES NO
1318137 Nicardipine NO YES NO
1318853 Nifedipine NO YES NO
1319880 Nisoldipine NO YES NO
1319998 Acebutolol NO YES NO
1322081 Betaxolol NO YES NO
1326012 Isradipine NO YES NO
1327978 Penbutolol NO YES NO
1328165 Diltiazem NO YES NO
1331235 quinapril NO YES NO
1332418 Amlodipine NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1338005 Bisoprolol NO YES NO
1340128 Captopril NO YES NO
1341238 Terazosin NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1344965 Guanfacine NO YES NO
1345858 Pindolol NO YES NO
1346686 eprosartan NO YES NO
1346823 carvedilol NO YES NO
1347384 irbesartan NO YES NO
1350489 Prazosin NO YES NO
1351557 candesartan NO YES NO
1353766 Propranolol NO YES NO
1353776 Felodipine NO YES NO
1363053 Doxazosin NO YES NO
1363749 Fosinopril NO YES NO
1367500 Losartan NO YES NO
1373225 Perindopril NO YES NO
1373928 Hydralazine NO YES NO
1386957 Labetalol NO YES NO
1395058 Chlorthalidone NO YES NO
1398937 Clonidine NO YES NO
40226742 olmesartan NO YES NO
40235485 azilsartan NO YES NO

B.6 Patients initiating first-line therapy for hypertension

Initial Event Cohort

People having any of the following:

  • a drug exposure of First-line hypertension drugs (Table B.12) for the first time in the person’s history

with continuous observation of at least 365 days prior and 365 days after event index date, and limit initial events to: earliest event per person.

Inclusion Rules

Having all of the following criteria:

  • exactly 0 occurrences of a drug exposure of Hypertension drugs (Table B.13) where event starts between all days Before and 1 days Before index start date
  • and at least 1 occurrences of a condition occurrence of Hypertensive disorder (Table B.14) where event starts between 365 days Before and 0 days After index start date

Limit cohort of initial events to: earliest event per person. Limit qualifying cohort to: earliest event per person.

End Date Strategy

No end date strategy selected. By default, the cohort end date will be the end of the observation period that contains the index event.

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 0 days.

Concept Set Definitions

Table B.12: First-line hypertension drugs
Concept Id Concept Name Excluded Descendants Mapped
907013 Metolazone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
1307863 Verapamil NO YES NO
1308216 Lisinopril NO YES NO
1308842 valsartan NO YES NO
1310756 moexipril NO YES NO
1317640 telmisartan NO YES NO
1318137 Nicardipine NO YES NO
1318853 Nifedipine NO YES NO
1319880 Nisoldipine NO YES NO
1326012 Isradipine NO YES NO
1328165 Diltiazem NO YES NO
1331235 quinapril NO YES NO
1332418 Amlodipine NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1340128 Captopril NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1346686 eprosartan NO YES NO
1347384 irbesartan NO YES NO
1351557 candesartan NO YES NO
1353776 Felodipine NO YES NO
1363749 Fosinopril NO YES NO
1367500 Losartan NO YES NO
1373225 Perindopril NO YES NO
1395058 Chlorthalidone NO YES NO
40226742 olmesartan NO YES NO
40235485 azilsartan NO YES NO
Table B.13: Hypertension drugs
Concept Id Concept Name Excluded Descendants Mapped
904542 Triamterene NO YES NO
907013 Metolazone NO YES NO
932745 Bumetanide NO YES NO
942350 torsemide NO YES NO
956874 Furosemide NO YES NO
970250 Spironolactone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
991382 Amiloride NO YES NO
1305447 Methyldopa NO YES NO
1307046 Metoprolol NO YES NO
1307863 Verapamil NO YES NO
1308216 Lisinopril NO YES NO
1308842 valsartan NO YES NO
1309068 Minoxidil NO YES NO
1309799 eplerenone NO YES NO
1310756 moexipril NO YES NO
1313200 Nadolol NO YES NO
1314002 Atenolol NO YES NO
1314577 nebivolol NO YES NO
1317640 telmisartan NO YES NO
1317967 aliskiren NO YES NO
1318137 Nicardipine NO YES NO
1318853 Nifedipine NO YES NO
1319880 Nisoldipine NO YES NO
1319998 Acebutolol NO YES NO
1322081 Betaxolol NO YES NO
1326012 Isradipine NO YES NO
1327978 Penbutolol NO YES NO
1328165 Diltiazem NO YES NO
1331235 quinapril NO YES NO
1332418 Amlodipine NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1338005 Bisoprolol NO YES NO
1340128 Captopril NO YES NO
1341238 Terazosin NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1344965 Guanfacine NO YES NO
1345858 Pindolol NO YES NO
1346686 eprosartan NO YES NO
1346823 carvedilol NO YES NO
1347384 irbesartan NO YES NO
1350489 Prazosin NO YES NO
1351557 candesartan NO YES NO
1353766 Propranolol NO YES NO
1353776 Felodipine NO YES NO
1363053 Doxazosin NO YES NO
1363749 Fosinopril NO YES NO
1367500 Losartan NO YES NO
1373225 Perindopril NO YES NO
1373928 Hydralazine NO YES NO
1386957 Labetalol NO YES NO
1395058 Chlorthalidone NO YES NO
1398937 Clonidine NO YES NO
40226742 olmesartan NO YES NO
40235485 azilsartan NO YES NO
Table B.14: Hypertensive disorder
Concept Id Concept Name Excluded Descendants Mapped
316866 Hypertensive disorder NO YES NO

B.7 Patients initiating first-line therapy for hypertension with >3 yr follow-up

Same as cohort definition B.6 but with continuous observation of at least 365 days prior and 1095 days after event index date

B.8 ACE inhibitor use

Initial Event Cohort

People having any of the following:

  • a drug exposure of ACE inhibitors (Table B.15)

with continuous observation of at least 0 days prior and 0 days after event index date, and limit initial events to: all events per person.

Limit qualifying cohort to: all events per person.

End Date Strategy

This strategy creates a drug era from the codes found in the specified concept set. If the index event is found within an era, the cohort end date will use the era’s end date. Otherwise, it will use the observation period end date that contains the index event.

Use the era end date of ACE inhibitors (Table B.15)

  • allowing 30 days between exposures
  • adding 0 days after exposure end

Cohort Collapse Strategy

Collapse cohort by era with a gap size of 30 days.

Concept Set Definitions

Table B.15: ACE inhibitors
Concept Id Concept Name Excluded Descendants Mapped
1308216 Lisinopril NO YES NO
1310756 moexipril NO YES NO
1331235 quinapril NO YES NO
1334456 Ramipril NO YES NO
1335471 benazepril NO YES NO
1340128 Captopril NO YES NO
1341927 Enalapril NO YES NO
1342439 trandolapril NO YES NO
1363749 Fosinopril NO YES NO
1373225 Perindopril NO YES NO

B.9 Angiotensin receptor blocker (ARB) use

Same as cohort definition B.8 with Angiotensin Receptor Blockers (ARBs) (Table B.16) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.16: Angiotensin Receptor Blockers (ARBs)
Concept Id Concept Name Excluded Descendants Mapped
1308842 valsartan NO YES NO
1317640 telmisartan NO YES NO
1346686 eprosartan NO YES NO
1347384 irbesartan NO YES NO
1351557 candesartan NO YES NO
1367500 Losartan NO YES NO
40226742 olmesartan NO YES NO
40235485 azilsartan NO YES NO

B.10 Thiazide or thiazide-like diuretic use

Same as cohort definition B.8 with Thiazide or thiazide-like diuretic (Table B.17) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.17: Thiazide or thiazide-like diuretic
Concept Id Concept Name Excluded Descendants Mapped
907013 Metolazone NO YES NO
974166 Hydrochlorothiazide NO YES NO
978555 Indapamide NO YES NO
1395058 Chlorthalidone NO YES NO

B.11 dihydropyridine Calcium Channel Blocker (dCCB) use

Same as cohort definition B.8 with dihydropyridine Calcium Channel Blocker (dCCB) (Table B.18) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.18: Dihydropyridine Calcium channel blockers (dCCB)
Concept Id Concept Name Excluded Descendants Mapped
1318137 Nicardipine NO YES NO
1318853 Nifedipine NO YES NO
1319880 Nisoldipine NO YES NO
1326012 Isradipine NO YES NO
1332418 Amlodipine NO YES NO
1353776 Felodipine NO YES NO

B.12 non-dihydropyridine Calcium Channel Blocker (ndCCB) use

Same as cohort definition B.8 with non-dihydropyridine Calcium channel blockers (ndCCB) (Table B.19) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.19: non-dihydropyridine Calcium channel blockers (ndCCB)
Concept Id Concept Name Excluded Descendants Mapped
1307863 Verapamil NO YES NO
1328165 Diltiazem NO YES NO

B.13 beta blocker use

Same as cohort definition B.8 with Beta blockers (Table B.20) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.20: Beta blockers
Concept Id Concept Name Excluded Descendants Mapped
1307046 Metoprolol NO YES NO
1313200 Nadolol NO YES NO
1314002 Atenolol NO YES NO
1314577 nebivolol NO YES NO
1319998 Acebutolol NO YES NO
1322081 Betaxolol NO YES NO
1327978 Penbutolol NO YES NO
1338005 Bisoprolol NO YES NO
1345858 Pindolol NO YES NO
1346823 carvedilol NO YES NO
1353766 Propranolol NO YES NO
1386957 Labetalol NO YES NO

B.14 Diuretic-loop use

Same as cohort definition B.8 with Diuretics - Loop (Table B.21) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.21: Diuretics - Loop
Concept Id Concept Name Excluded Descendants Mapped
932745 Bumetanide NO YES NO
942350 torsemide NO YES NO
956874 Furosemide NO YES NO

B.15 Diuretic-potassium sparing use

Same as cohort definition B.8 with Diuretics - potassium sparing (Table B.22) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.22: Diuretics - potassium sparing
Concept Id Concept Name Excluded Descendants Mapped
904542 Triamterene NO YES NO
991382 Amiloride NO YES NO

B.16 alpha-1 blocker use

Same as cohort definition B.8 with Alpha-1 blocker (Table B.23) in place of ACE inhibitors (Table B.15).

Concept Set Definitions

Table B.23: Alpha-1 blocker
Concept Id Concept Name Excluded Descendants Mapped
1341238 Terazosin NO YES NO
1350489 Prazosin NO YES NO
1363053 Doxazosin NO YES NO