Prescription patterns of antihypertensives in a community-health centre in Mexico City: a drug utilization study (original) (raw)
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Control of hypertension in patients at high risk of cardiovascular disease
QJM, 2005
Background: Hypertension is a major cardiovascular risk factor, but knowledge about the real magnitude of the problem and its determinants is lacking. Aim: To assess control of hypertension and evaluate medical resource use, in patients at high risk of cardiovascular disease. Design: Multicentric cross-sectional study. Methods: We collected data for 2205 adult patients from 36 centres, representative of all regions of Spain. Patients had attended outpatient clinics from July 2002 to August 2003, had an absolute cardiovascular risk 520% at 10 years (according to the Framingham guidelines), and had a diagnosis of hypertension. Pregnant and terminally ill patients were excluded. Results: Hypertension was inadequately controlled in 1384 patients (62.8%). LDL cholesterol was higher in patients with uncontrolled hypertension (median 130.2 vs. 120.0 mg/dl, p 5 0.001). Haemoglobin A 1c in diabetic patients was also greater in those with uncontrolled hypertension (median 7.10% vs. 6.90%, p ¼ 0.010). Uncontrolled hypertension was associated with the following variables, in descending strength of association: higher LDL cholesterol, taking antihypertensive medication, living in non-metropolitan areas, and higher body mass index. Discussion: Hypertension is poorly controlled in most patients with a high risk of cardiovascular disease. Uncontrolled hypertension is frequently associated with poor control of other risk factors.
Journal of Hypertension, 2016
Design and method: Between January and June 2015, 388 general practitioners retrospectively collected data from 4110 consecutive hypertensive patients recently seen in their routine practice and taking at least 2 antihypertensive drugs. Results: Patients (mean age 67 ± 25 years [±SD], 55% men, 31% with diabetes mellitus, 31% with a previous cardiovascular event) were treated with 2 (n = 2302), 3 (n = 1313), or > 3 (n = 495) antihypertensive drugs. Combinations were free (n = 1577), fi xed (n = 1345), or mixed (n = 1148) (missing data, n = 40). BP was 140 ± 23/82 ± 11 mmHg (mean ± SD). According to the 2013 ESH/ ESC Guidelines, BP control rates were: systolic BP 49%, diastolic BP 72%, both systolic and diastolic BP 44%. According to the 2009 ESH/ESC Guidelines, systolic and diastolic BP control rate was 20%. Estimation by the GPs of systolic and diastolic BP control was 62%. Many physicians expressed the intent to prescribe fi xed-dose combinations of bitherapy (in 896 patients) or of tritherapy (in 1394 patients) instead of free combinations. Reasons for this were improved adherence (73%) and better BP control (71%). Conclusions: Free combinations remain largely used although GPs seem prone to prescribe fi xed-dose combinations. In these high-risk patients requiring at least 2 antihypertensive drugs, BP control rate remains low and is overestimated by GPs. Increasing prescriptions of fi xed-dose combinations could improve patient adherence and BP control.
8 The Use of Antihypertensive Medicines in Primary Health Care Settings
2017
On the other side, despite the availability of a wide range of antihypertensive drugs (Van Bortel and others 2011), blood pressure has remained poorly controlled in a majority of health www.intechopen.com Antihypertensive Drugs 132 care settings, particularly in low resource settings. The access to medicines is highly driven by the availability and the cost of these drugs and strongly influences the prescription and usage patterns which in the end affect control of blood pressure(Twagirumukiza and others 2010). The rational use of available resources and the integration of the management strategies at primary health care level (De Maeseneer J 2009) have been advocated as key point of improving hypertension treatment (Twagirumukiza and Van Bortel 2011). The aim of this chapter summarize the current knowledge on the use of antihypertensives in primary care and to provide an update to prescribers and health professionals in their daily questions about whom-and-how to treat-as far as arterial hypertension is concerned. 3. Epidemiology of hypertension Arterial hypertension (HT) refers to a permanently and abnormally elevated arterial blood pressure. Arterial blood pressure (BP) corresponds to the force exerted by the circulating blood on the walls of blood vessels, and constitutes one of the cardinal vital clinical signs (Nichols WW. and others 2011). Hypertension can be classified either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (pheochromocytoma among others). In current usage, the word "hypertension" once used without a qualifier will refers to essential systemic, arterial hypertension. According to the World Health Organization (WHO) (World Health Organization and others 2004), hypertension is one of 7 diseases composing the entity of "cardiovascular diseases" (CVDs). This entity list includes, besides hypertension, coronary heart disease, cerebrovascular disease, peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure (Lopez and others 2006; World Health Organization and others 2004). By its target organ damage (TOD) hypertension remains an important cause of coronary heart disease, cerebrovascular disease, peripheral artery disease, and heart failure, which counts together with congenital heart disease for more than 75% of the CVDs morbimortality worldwide. The epidemiology of hypertension is therefore linked to CVDs and within this chapter, is considered both as a disease and as a risk factor for other CVDs. Cardiovascular diseases, especially hypertension and related risk factors are of real health concern worldwide (Lawes and others 2008). Currently, the majority of hypertensive people live in developing regions (Kearney and others 2005), where their number is presumed to increase in coming decades (Kearney and others 2005), which inevitably will lead to a higher burden of cardiovascular diseases (Kearney and others 2005; Murray and Lopez 1997). Within a context of limited data on the burden of hypertension and other chronic diseases in many developing countries (Murray and Lopez 1997), those diseases are very often considered as uncommon and therefore they are rarely addressed by policy makers (Unwin and others 2001) who are very often focused on a well described predominance of infectious diseases in these regions (Unwin and others 2001). Nevertheless, hypertension should be considered of great economic importance also in developing countries and regions like in Latina America, South Asia and sub-Saharan Africa, because it is frequently underdiagnosed, and frequently undertreated, as patients often cannot afford treatment. In such situations, the complications of hypertension are
BMC Cardiovascular Disorders, 2019
Background: To determine the prevalence of hypertension treatment and control among hypertensive patients in the Cuban municipalities of Cardenas and Santiago and to explore the main associated predictors. Methods: Cross-sectional study, with multistage cluster sampling, conducted between February 2012 and January 2013 in two Cuban municipalities. We interviewed and measured blood pressure in 1333 hypertensive patients aged 18 years or older. Hypertension control was defined as blood pressure lower than 140/90 mmHg. Results: The mean age ± standard deviation (SD) of participants was 59.8 ± 14 years, the mean systolic and diastolic blood pressure ± SD was 130.0 ± 14.4 and 83.1 ± 9.0 mmHg respectively. The majority of patients (91, 95%CI 90-93) were on pharmacological treatment, 49% with a combination of 2 or more classes of drugs. Among diagnosed hypertensive patients 58% (95%CI 55-61) had controlled hypertension. There was no association between hypertension control and gender, age and socioeconomic condition. Levels of hypertension control depended on health area and control furthermore was positively associated with post-primary education, not being obese and white ethnicity: adjusted Odds Ratio (95% CI) 1.71 (1.26-2.34), 1.43 (1.09-1.88) and 1.41 (1.09-1.81) respectively. Conclusions: The observed figures are outstanding at the international level and illustrate that hypertension treatment and control are achievable in a resource-constrained setting such as Cuba. The country's primary health care approach and social equity in access to health care can be seen as key determinants of this success. Nevertheless, there is still room for improvement, as over a third of patients did not have controlled hypertension.
The use of antihypertensive medicines in primary health care settings
2012
On the other side, despite the availability of a wide range of antihypertensive drugs (Van Bortel and others 2011), blood pressure has remained poorly controlled in a majority of health www.intechopen.com Antihypertensive Drugs 132 care settings, particularly in low resource settings. The access to medicines is highly driven by the availability and the cost of these drugs and strongly influences the prescription and usage patterns which in the end affect control of blood pressure(Twagirumukiza and others 2010). The rational use of available resources and the integration of the management strategies at primary health care level (De Maeseneer J 2009) have been advocated as key point of improving hypertension treatment (Twagirumukiza and Van Bortel 2011). The aim of this chapter summarize the current knowledge on the use of antihypertensives in primary care and to provide an update to prescribers and health professionals in their daily questions about whom-and-how to treat-as far as arterial hypertension is concerned. 3. Epidemiology of hypertension Arterial hypertension (HT) refers to a permanently and abnormally elevated arterial blood pressure. Arterial blood pressure (BP) corresponds to the force exerted by the circulating blood on the walls of blood vessels, and constitutes one of the cardinal vital clinical signs (Nichols WW. and others 2011). Hypertension can be classified either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (pheochromocytoma among others). In current usage, the word "hypertension" once used without a qualifier will refers to essential systemic, arterial hypertension. According to the World Health Organization (WHO) (World Health Organization and others 2004), hypertension is one of 7 diseases composing the entity of "cardiovascular diseases" (CVDs). This entity list includes, besides hypertension, coronary heart disease, cerebrovascular disease, peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure (Lopez and others 2006; World Health Organization and others 2004). By its target organ damage (TOD) hypertension remains an important cause of coronary heart disease, cerebrovascular disease, peripheral artery disease, and heart failure, which counts together with congenital heart disease for more than 75% of the CVDs morbimortality worldwide. The epidemiology of hypertension is therefore linked to CVDs and within this chapter, is considered both as a disease and as a risk factor for other CVDs. Cardiovascular diseases, especially hypertension and related risk factors are of real health concern worldwide (Lawes and others 2008). Currently, the majority of hypertensive people live in developing regions (Kearney and others 2005), where their number is presumed to increase in coming decades (Kearney and others 2005), which inevitably will lead to a higher burden of cardiovascular diseases (Kearney and others 2005; Murray and Lopez 1997). Within a context of limited data on the burden of hypertension and other chronic diseases in many developing countries (Murray and Lopez 1997), those diseases are very often considered as uncommon and therefore they are rarely addressed by policy makers (Unwin and others 2001) who are very often focused on a well described predominance of infectious diseases in these regions (Unwin and others 2001). Nevertheless, hypertension should be considered of great economic importance also in developing countries and regions like in Latina America, South Asia and sub-Saharan Africa, because it is frequently underdiagnosed, and frequently undertreated, as patients often cannot afford treatment. In such situations, the complications of hypertension are
Current Status of Hypertension Control Around the World
Clinical and Experimental Hypertension, 2004
It is well established that hypertension is an important risk factor for cardiovascular disease. Data from epidemiological and observational studies have demonstrated increasing risk of stroke, myocardial infarction, cardiovascular death and all cause mortality associated with high blood pressure. Despite the significance of the problem with respect to overall health, control of high blood pressure is far from being optimal. Data from the National Health and Nutrition Survey have shown that those achieving target blood pressure values less than 140/90 mmHg are only 34% of the hypertensive population. The situation is no better in the rest of the world and even worse in the developing countries. Epidemiological transition taking place in developing countries with a decline in communicable diseases and an increase in noncommunicable have resulted in an improvement in life expectancy, thus causing predictable shifts in causes of death. Aging of the populations, urbanization and socioeconomic changes in the developing world have led to an increase in the prevalence of hypertension, with low control rates due to scarce health resources and insufficient health infrastructure. Thus prevention, detection, treatment and control of hypertension play a crucial role in protection of cardiovascular disease, not only in the developed countries but also in
Pharmacy World & Science, 2009
Objectives The aim of this study is to determine the influence that different risk factors (age, gender, obesity, smoking, inactivity, diabetes mellitus and previous diagnosis of arterial hypertension) have on arterial pressure, and to determine the prevalence of patients that have high blood pressure and hypertension but have not received drug-treatment for arterial hypertension. Setting 42 Spanish community pharmacies. Method Observational and descriptive study. Patients included in the study were over 18 years of age, not receiving pharmacological treatment for arterial hypertension and not pregnant. Two measurements of arterial pressure were taken from each patient on the first day of the study and two other measurements on a later day. The average of these four measurements was taken as the arterial pressure value for the patient. All measurements were taken in the participating community pharmacies, always by the pharmacist and following the same protocols. The measurements were noted in the patients’ records along with data about the seven risk factors being studied, allowing them to be related with the patient’s arterial pressure value. Results The number of patients invited to join the study was 3,760, of whom 2,574 agreed to participate, with 2,094 completing the study. It was found that an increase in the number of risk factors led to a corresponding rise in the percentage of patients with high blood pressure and arterial hypertension. The risk of having arterial hypertension was 4.23 times higher in patients aged 65 years and over. It was also 2.88 times greater in those who had been previously diagnosed with arterial hypertension, 2.79 times higher in overweight or obese patients, 2.69 times more in diabetics and 2.22 times higher in men compared with in women. Prevalence of high blood pressure in patients not receiving pharmacological treatment for arterial hypertension was 33.6%, and prevalence of arterial hypertension was 22.8%. Conclusions Of the people studied, 22.8% had arterial hypertension. For the risk factors identified, those most related to the presence of arterial hypertension were, in descending order: being 65 years old or over, previous diagnosis of arterial hypertension, being overweight or obese, being diabetic and being male.
Journal of Hypertension, 1997
Background The antihypertensive efficacy of drug therapy and of some nonpharmacologic recommendations has been demonstrated in controlled clinical trials, but not in a clinical setting. Objective To assess the antihypertensive effectiveness of drug therapy and of three nonpharmacologic recommendations (loss of weight, salt-intake restriction, and physical exercise). Design A prospectively planned cohort study. Setting A hospital-based hypertensive outpatient clinic. Patients We studied 637 patients (65.5% women) with systolic blood pressures above 140 mmHg or diastolic blood pressures above 90 mmHg, corresponding to 76% of 839 patients who were administered a prescription for hypertension and who returned for the first follow-up visit 3.5 months later on average. Methods The nonpharmacologic prescription consisted of salt-intake restriction for all, weight reduction for overweight patients, and practice of aerobic physical exercise for those for whom it was not contraindicated; 60% of the patients were treated with drugs according to standard recommendations. Patients treated with drugs were compared with untreated subjects; for the nonpharmacologic interventions, the groups were compared according to their reported compliances with the recommendations (at least some compliance versus none). The main outcome measures were variations in systolic and diastolic blood pressures between the baseline evaluation and the first follow-up visit and an improvement in prognosis, represented by a favorable change in the classification of the blood pressure (according to Joint National Committee V criteria). Results The cohort constituted predominantly lowincome, middle-aged, overweight white women, with low-to-moderate hypertension of long duration. The group treated with drugs exhibited the greatest reduction in blood pressure, with clinical significance even discounting the losses in follow-up; the group of patients who reported compliance with the low-energy-intake diet also showed a consistent antihypertensive effect, which was still detectable on the occasion of the third follow-up visit 9 months after the first prescription; reported compliance with a low-sodium diet and practice of physical exercise were not associated with a reduction in blood pressure; among a subset of the patients, reported compliance with the salt-intake-restricted diet did not reduce the amount of sodium to the theoretical antihypertensive threshold. It was not possible to determine whether the lack of an antihypertensive effect of physical exercise for this cohort was secondary to a misreport of the extent of compliance or to an absence of effect of the intensity of training prescribed. The effects of drug therapy and compliance with a lowenergy-intake diet were shown to be independent of other interventions or confounders. Conclusion The antihypertensive effect of drugs demonstrated in well-controlled clinical trials is achievable in clinical practice. The recommendation to lose weight was the only nonpharmacologic intervention with a detectable antihypertensive effect in this cohort. The absence of effect of a low-sodium diet is probably secondary to the insufficient reduction in the amount of salt consumed. The lack of an antihypertensive effect of physical exercise could reflect either a misreported compliance or an absence of effect of the intensity of training recommended in this study.