The main outcome was the use of first-generation ARBs (valsartan, candesartan, and losartan). Specifically, we began with the defined daily dose [DDD] per 1,000 persons. Then, for each month from April 2005 to March 2017, we computed the number of patients who received the drugs, that is, the country-level aggregated drug dose divided by the DDD (eTable 1).29 The DDD is “the average maintenance dose of the drug” and is approved by the World Health Organization (WHO). To calculate the numbers of patients receiving the drugs per 1,000 persons, we used the total number of residents of Japan from census data.27 Patients receiving angiotensin-converting-enzyme (ACE) inhibitors comprised the control group.
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