| Background:Hypertension is one of the most important modifiable cardiovascular risk factor accounting for high morbidity and mortality worldwide. Epidemiological studies have shown the benefits of lowering the blood pressure and efficacy of antihypertensive treatment. Despite the wide availability of antihypertensive agents, blood pressure control remains a challenge. Therefore, it is of utmost importance to understand the current patterns of antihypertensive drug use and to assess the impact of pharmacological treatment on blood pressure control rates.Objective:To describe the current antihypertensive medication utilization pattern and blood pressure control rate among adult patients with essential hypertension attending hypertension outpatient clinic. Also, findings from this study might help in understanding effectiveness of different antihypertensive drugs which may help to elevate blood pressure control rates.Methods:The study was an outpatient based descriptive cross sectional design which was conducted during the period from January2013to January2014at hypertension outpatient clinic of the third Xiangya Hospital, Central South University. Inclusion criteria:1.The study population were all hypertensive patients above and equal to18years of age,2.without secondary hypertension and co-morbidities (coronary artery disease, stroke, diabetes, renal disease, etc.),3.who were taking antihypertensive agents regularly for more than3months. In this study data was collected using structured questionnaires and measurements. Questionnaire included questions about demographic characteristics, antihypertensive drugs individual patients were taking, previous blood pressure level (before starting antihypertensive medication), duration of hypertension, smoking history and family history. Measurements consisted of height, weight, heart rate, blood pressure measurements. Blood pressure control was defined as pharmacological treatment of hypertension associated with an average systolic blood pressure(SBP)/diastolic blood pressure (DBP)<140mmHg/<90mmHg on the basis of the2013guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). In this study, five main classes of antihypertensive drugs (diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers) were included. Data was initially recorded in Microsoft Excel program and was later analyzed using SPSS software program (20.0). Continuous variables were presented as mean±standard deviation (x±s) and categorical variables as percentages. Chi-square test (x2) was used to test differences between proportions when required. A p-value less than0.05were considered significant.Results:1. Analyses were performed on the collected data of1529treated hypertensive patients. The patients’mean age (SD)59.47+(12.64);53.4%was women while46.6%; mean SBP was143.67±18.95mmHg and mean DBP was83.12±12.24mmHg.2. Blood pressure control was achieved in33.7%of patients. BP control rate was significantly higher in men than women among middle age group (41.6%vs31.2%). There was significant difference in BP control rate among male patients of different age groups showing higher control rate among middle aged patients while lowest among old age groups. Bp control rate was lower among women with higher BMI (27.2%in overweight,32.3%in obese females) while male showed low BP control rate among smokers (38.3%).3. Among all patients, rate of monotherapy use was higher (52.2%); CCBs was the most commonly prescribed antihypertensive drug as a monotherapy (59.6%), ACEI, ARB and BB showed similar prescription rate; diuretics were the least preferred drug (14.6%). Among two drug combination CCB+ARB (35.7%) had the highest utilization rate. The utilization rate for2antihypertensive drug was34.4%and for>3antihypertensive drugs was13.4%; among these patients blood pressure was better controlled compared to patients using single drug therapy (28.3%vs.38.4%28.3%vs.42.4%, P<0.05).4. There was significant age dependent difference in control rate among some drug classes between male and female, and also within the same gender of particular age group. Male patients were found to be better controlled with ACEIs compared to females (18-45years61.5%vs.9.5%,45-65years3.3%vs.24.5%,>65years36.2%vs.25.4%p<0.05) in all three age groups. CCBs showed a better control rate in males compared to female patients in middle aged group (40.2%vs.28.3%, p... |
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