Investigation of drug use in essential hypertension patients with or without cardiovascular comorbidity

Year 2020, , 117 - 130, 31.08.2020

Dilara Bayram Volkan Aydın Orkun Celil Sel Ali Serdar Fak , Mehmet Akman , Zehra Aysun Altıkardeş , Ahmet Akıcı

https://doi.org/10.5505/deutfd.2020.05900

Abstract

INTRODUCTION: Comorbidities are common in hypertension (HT) and determine management of antihypertensive therapy. We aimed to investigate drug utilization in hypertensive patients based on the presence of other cardiovascular problems.
METHODS: This retrospective study included data of patients applied to the Turkish Heart Foundation Medical Center between January 2016-June 2018 (n=11.085). Among all medical records (n=26.699), medications, medical and demographic characteristics were evaluated in patients with most common diagnosis: HT, ischemic heart disease (IHD), and dyslipidemia (DL). Data for HT and accompanying IHD and DL were compared.
RESULTS: 22.2% (n=5929) of the visits had diagnosis of HT. Of the total 3601 HT patients, 43.7% (n=1572) had single diagnosis and 36.7% (n=1321) had at least one of the two comorbidities. Acetylsalicylic acid was the most common drug in all groups. The most common antihypertensive group was renin-angiotensin system (RAS) blockers and the active molecules were metoprolol and amlodipine. This was followed by “valsartan+hydrochlorothiazide” in HT alone or HT+DL groups and by ramipril in the groups where IHD accompanied. The use of beta-blockers was lower in patients ≥65 years compared to younger patients (13.8% and 16.1%, respectively, p<0.05).
DISCUSSION AND CONCLUSION: In this study, the most preferred antihypertensive group was drugs acting on RAS, dominated by angiotensin receptor blockers and most preferred drug was metoprolol. Contrary to their comparably deprioritization in recent guidelines, beta-blockers seem to be widely used in this setting. It is understood that the most commonly used drugs do not vary overall in the studied comorbidities of HT.

Keywords

drug utilization, antihypertensive agents, ischemic heart disease, dyslipidemia

Kardiyovasküler komorbiditesi bulunan ve bulunmayan esansiyel hipertansiyon hastalarında ilaç kullanımının araştırılması

Abstract

GİRİŞ ve AMAÇ: Hipertansiyon, komorbiditesi sık bir hastalık olup bu durum tedaviyi düzenlenmede belirleyicidir. Bu çalışmada hipertansif hastalarda başka kardiyovasküler problemin olup olmama durumuna göre ilaç kullanımının incelenmesi amaçlandı.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya Türk Kalp Vakfı Tıp Merkezi’nin Ocak 2016-Haziran 2018 arasındaki hasta verileri dahil edildi (n=11.085). Hastalara ait kayıtlı tanılar içerisinde (n=26.699) en sık karşılaşılan üç tanı olan hipertansiyon (HT), iskemik kalp hastalığı (İKH) ve dislipidemi (DL) bulunanların tedavilerindeki ilaçları, tıbbi ve demografik özellikleri değerlendirildi. HT verileri ile buna eşlik eden İKH ve DL verileri karşılaştırıldı.
BULGULAR: Çalışma periyodunda oluşturulan protokollerin %22,2’sini (n=5929) HT oluşturmaktaydı. Toplam 3601 HT tanılı hastanın %43,7’sini (n=1572) tek tanılı olanlar, %36,7’sini ise (n=1321) eşlik eden iki komorbiditenin en az birini içeren hastalar oluşturuyordu. İncelenen tüm tanı gruplarında en sık karşılaşılan ilaç asetilsalisilik asit idi. En sık karşılaşılan antihipertansif ana ilaç grubu renin-anjiyotensin sistemi (RAS) blokerleri, etkin maddeler ise metoprolol ve amlodipin idi. Bunu tek başına HT ve HT’ye DL’nin eşlik ettiği grupta “valsartan+hidroklorotiyazid”, İKH’nin eşlik ettiği gruplarda ramipril izliyordu. Beta-bloker kullanımı ≥65 yaş hastalarda genç hastalara kıyasla daha düşüktü (sırasıyla %13,8 ve %16,1, p<0,05).
TARTIŞMA ve SONUÇ: Bu çalışmada en çok tercih edilen antihipertansif grubun, anjiyotensin reseptör blokerlerinin baskınlığında, RAS üzerinden etkililer, en çok tercih edilen ilacın ise metoprolol olduğu göze çarpmaktadır. Son yıllardaki kılavuzlarda beta-bloker kullanımının nispeten geri plana düşmüş olmasına rağmen, bu çalışmada hipertansif hastalarda yaygın olarak kullanıldığı görülmektedir. HT’ye eşlik eden iki durumda da en sık kullanılan ilaçların genel olarak değişkenlik göstermediği anlaşılmaktadır.

Keywords

ilaç kullanımı, antihipertansif ajanlar, iskemik kalp hastalığı, dislipidemi

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