The Clinical Application Ofantihypertensive Drugs In A Hospital And A Meta-analysis Of The Effectiveness And Safety Of Typical Drug

Objective To investigate the clinical application of seven different classes ofantihypertensive drugs of outpatients in a major hospital in Taiyuan,ShanxiProvince. The calcium channel blockers are the most widely used in this hospital.Then we conduct a systematic review of effectiveness and safety oflevoamlodipine and amlodipine which are used to treat essential hypertension byorally to provide economical, reasonable safe, effective scientific basis for clinicalmedication.Methods To collect statastics of hypertensive prescription in2012andsubtotal them according to generic drugs by using Microsoft excel software, Tocompute the data sorted by anti-hypertensive drug type, quantity, and the sums ofmoney,and calculate the proportion of different classes.After searching pubmed database WanFang database, China NationalKnowledge Infrastructure(CNKI) and VIP database (VIP), Randomized controlledtrials （RCT） on amlodipine and levoamlodipine in the treatment of essentialhypertension were included.and the methodological quality was evaluated usingRedman4.2software.Results.(1) Calculate sales amount of seven different classes of antihypertensive drugsand then sorted, the first three is CCB, ARB, β-RB and the diuretics and a1–blockers were used relatively little.(2) CCB is the main anti-hypertensive drugs among7different classes ofdrugs.and was used conmontly in all of the anti-hypertensive drugs.(3) The application of antihypertensive drugs were mainly Calcium channelblockers in the top10DDDs of antihypertensive drugs. Levamlodipine,nifedipine,amlodipine were located at the first place,the third place, and the forthplace。(4) The application of antihypertensive drugs in the " National EssentialDrugs List " and " Shanxi supplement catalog " conforms with proportion ofsales amount in basic primary hospital and related requirements of the Ministry ofHealth, T Antihypertensive drugs cover different varieties and each of them hasspecific characters. (5) Calcium channel blockers, a relatively low value to DDC nifedipine,levamlodipine, higher values of imported drugs DDC amlodipine, CCB joint drugclass DDC value is relatively higher than the matter of domestic drugs to the valueof long-acting drugs DDDs and joint high.(6) The combination use of β-receptor antagonists, calcium channelblockers,Angiotension II receptor blocker in two-drugs or three-drugs wererelatively common.The consistent with the recommendations ESH/ESChypertension study guide presents the advantages of combinations, while also inline with a combination of the most widely reported in the literature.(7) By the literature search were included levamlodipine with amlodipinetreatment of hypertension randomized controlled trials (RCT),37RCT,total of5297cases of patients were included. Meta-analysis results showed thatL-amlodipine and amlodipine Meta-analysis showed that both levamlodipine andamlodipine were effective in lowering blood pressure, total efficiency OR=0.82,95%CI (0.69,0.97), P=0.02; and24h average diastolic blood pressureWMD=-0.82,95%CI (-1.50,-0.14), P=0.02; decreased value of systolic bloodpressure SMD=-5.8,95%CI (-8.81,-1.76), P=0.03; the number of doses increaseOR=0.73,95%CI (0.54,0.99), P=0.04; incidence of adverse drugreaction.OR=0.36,95%CI (0.29,0.45), P<0.00001; there were statisticallysignificant.24h average diastolic blood pressure WMD=0.24,95%CI (-0.40,0.88), P=0.47,decreased value of systolic blood pressure difference between thetwo groups was not statistically significant, the combined effect size SMD=-1.37,95%CI (-3.15,0.40), P=0.13.Conclusion(1)The sum of consumption of CCB,ARB,β-RB and DDDs of application ofantihypertensive in the hospital were the top3.(2) The amount of essential drugs used in hospitals complyed with therelevant provisions and drug sales amount is of essential drugs anti-hypertensionover25-30%of the total amount.(3) The value of the DDDs ranked the top ten drugs, L-amlodipine,amlodipine are located in the first and fourth.(4)95%of the value of the drug DDC was between0to6.99Yuan, we canconcluded that the application of anti-hypertensive drugs was at the medium and low prices.（5）Drug combination of the two drugs combination was the mainly can bebased, triple, and quadruple less prescription medication.(6) Compliance with ESH/ESC hypertension study guide with suggestionsput forward the advantages of the combination, while in line with a combination ofwas the most widely reported in the literature.(7) According to the result of Meta-analysis,levamlodipine is not only betterthan amlodipine on the treatment of hypertension, but also24-hour ambulatorydiastolic blood pressure and systolic blood pressure clinic and fewer side effects;systolic blood pressure for24hours in a statistically does not make sense, in theclinical effect levamlodipine is better than amlodipine; clinic diastolic bloodpressure decreased in value in the two groups was not statistically significant, theclinical effects are relatively. On the whole, levamlodipine is better thanamlodipine. However, due to the limited quality of included studies, reducing thereliability of the system of evaluation findings, to further validate its efficacy andsafety, yet to be designed, the implementation of strict, multi-center andlarge-scale randomized concrolled trails with enough following-up should becarried out to validate the efficacy therapeutic and safety.