Frequent Change of Intra-group Drug Effect on the Blood Pressure Control and Adaptation of Therapy in Hypertensive Patients

Abstract

Introduction: In this study, we investigated the effects of frequent and unnecessary change in medication to control of blood pressure. Also we investigated the role of the regular use of drugs in the treatment of hypertension. Patients and Methods: Nine hundred hypertensive patients (509 males and 391 females; mean age 62.4 ± 12.1 years) were evaluated retrospectively. Only the patients taking anti-hypertensives for at least six months were included. Patients' records were examined in terms of anti-hypertensive treatment. Intra-group exchange and use of regularly in anti-hypertensive drugs were investigated. Effects of the change in blood pressure and patient compliance were investigated. Results: When intra-group drug change was examined, rates of drug changes were as follows; angiotensin receptor blocker group, 62.3%; angiotensin converting enzyme group, 55.1%; betablockers group, 39.9%; calcium channel blocker group, 20.9%. While the ratio of non-compliance was 28.7% in the patient group with drug change, it was only 9.3% in the group without change in treatment. Average blood pressure difference was found 6.1 ± 7.6 mmHg and 7.6 ± 7.5 mmHg respectively (p < 0.001). The average number of drug usage with and without change of antihypertensive drug were 2.5 ± 0.87 and 2.2 ± 0.89 (p < 0.001) respectively. Conclusion: In patients under angiotensin converting enzyme inhibitors and angiotensin receptor blocker treatments, intra-group change of medication is common. Frequent intra-group change of anti-hypertensive drugs has negative effects on blood pressure control.

Keywords

• Hypertension; drug switching; patient compliance

Hipertansif Hastalarda Grup İçi Sık İlaç Değişiminin Kan Basıncı Kontrolüne ve Tedavi Uyumuna Etkisi

Abstract

Giriş: Bu çalışmada sık ve gereksiz ilaç değişiminin kan basıncı kontrolü üzerindeki etkisini araştırdık. Ayrıca, hipertansiyon tedavisinde düzenli ilaç kullanımının rolü çalışıldı. Hastalar ve Yöntem: Dokuz yüz hipertansif hasta (509 erkek ve 391 kadın; yaş ortalaması 62.4 ± 12.1 yıl) geriye dönük olarak değerlendirildi. En az altı aydır antihipertansif ilaç alan hastalar çalışmaya dahil edildi. Hasta kayıtları antihipertansif tedavi yönünden incelendi. Grup içi değişim ve antihipertansif ilaçların düzenli kullanımı araştırıldı. Değişimin kan basıncı ve hasta uyumuna etkisi araştırıldı. Bulgular: Grup içi ilaç değişim oranları; anjiyotensin reseptör bloker grubunda,%62.3; anjiyotensin dönüştürücü enzim grubunda,%55.1; beta-bloker grubunda,%39.9; kalsiyum kanal bloker grubunda,%20.9 olarak bulundu. Düzensiz ilaç kullanım oranı ilaç değişikliği olan hasta grubunda %28.7 iken, ilaç değişikliği olmayan hasta grubunda sadece %9.3 idi. Ortalama kan basıncı farkı sırasıyla 6.1 ± 7.6 mmHg ve 7.6 ± 7.5 mmHg idi (p < 0.001). Antihipertansif ilaç değişimi olan ve olmayan gruplarda kullanılan ortalama ilaç sayısı sırası ile 2.5 ± 0.87 ve 2.2 ± 0.89 idi (p < 0.001). Sonuç: Anjiyotensin dönüştürücü enzim inhibitörleri ve anjiyotensin reseptör bloker tedavisi altındaki hastalarda grup içi ilaç değişimi yaygındır. Antihipertansif ilaçların grup içi sık değişimi kan basıncı kontrolünü olumsuz etkiler.

Keywords

• Hipertansiyon, sık ilaç değişimi, hasta uyumu

References

1. Altun B, Arici M, Nergizoğlu G, Derici U, Karatan O, Turgan C. Prevalence, Awareness treatment and control of hypertension in Turkey (the PatenT study) in 2003. J Hypertens 2005;23:1817-23.
2. Onat A, Doğan Y, Uyarel H, Ceyhan K, Uzunlar B, Yazıcı M, et al. Blood pressure levels in Turkish adults: initial trend to improved blood pressure control. Turk Kardiyol Dern Ars 2002;30:749-57.
3. Heidenreich PA, Trogdon JG, Khaviou OA, Butler J, Dracup K, Ezekowitz MD. Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement from the American Heart Association. Circulation 2011; DOI: 10.1161/CIR.
4. Ozkara A, Turgut F, Selcoki Y, Kanbay M, Karakurt F, Tekin O. Ad- herence of patients to antihypertensive medication and to health care centers. Yeni Tıp Dergisi 2008;25:97-101.
5. Neal B, MacMahon S, Chapman N. Blood Pressure Lovering Treatment Trialist’ Collaboration. Effects of ACE inhibitors, calci- um antagonists and other blood-pressure-lowering drugs: result of prospectively designed overviews of randomised trials. Blo- od Pressure Lowering Treatment Trialists’ collaboration. Lancet 2000;356:1955-64.
6. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwi- de prevalence of hypertension: a systematic review. J Hypertens 2004;22:11-9.
7. Spence JD. Physiologic tailoring of treatment in resistant hyper- tension. Curr Cardiol Rev 2010;6:119-23.
8. Scheen AJ. Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 2. Overview of physiological and biochemi- cal mechanisms. Diabetes Metab 2004;30:498-505.

9. Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM. Im- pact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes. Diabetes Care 2007;30:1351-6.
10. The Seventh Report of the Joint National Committee on Detection, Evaluation and Treatment oh High Blood Pressure. National He- art, Lung and Blood Institute(US); August-2004.
11. Mohammadi E, Abedi HA, Gofranipour F, Jalali F. Partnership ca- ring: a theory of high blood pressure control in Iranian hypertensi- ves. Int J Nurs Pract 2002;8:324-9.
12. Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA 2004;291:1850-6.
13. Abacı A, Oguz A, Kozan O, Toprak N, Senocak H, Dger N et al. Treatment and control of hypertension in Türkish population: a survey on high blood pressure in primary care (the TURKSAHA study). J Hum Hypertens 2006;20:355-61.
14. Ubel PA, Jepson C, Asch DA. Misperceptions about beta-blokers and diüretics a national survey of primary care physicians. J Gen Intern Med 2003;18:977-83.
15. Clark LT. Improving compliance and increasing control of hyper- tension: needs of special hypertensive populations. Am Heart J 1991;121:664-9.
16. Fretheim A, Oxman AD. International variation in prescribing an- ti-hypertensive drugs: Its extent and possible explanations. BMC Health Serv Res 2005;5:21.