| Objective:To analyze the distribution characteristics of antihypertensive drug-related gene polymorphism in patients with essential hypertension(EH)in a hospital,explore the empirical medication based on antihypertensive drug-related genomics,assist doctors in individually control of patients’ blood pressure,and improve antihypertensive treatment effect of EH patients through individualized pharmaceutical care.To provide reference for clinical pharmacists to carry out individualized pharmaceutical care based on antihypertensive drug related genomics for EH patients in the future.Methods:This study is divided into two parts.In the first part,180 EH patients were selected from September 2018 to August 2020 who were tested for gene polymorphism at 8 loci related to 5 categories of antihypertensive drugs in the pharmacy department of the hospital.To analyze the distribution characteristics of antihypertensive drug-related gene polymorphism in EH patients,compare the distribution differences of gene polymorphism between different gender and different BMI patients,so as to provide an empirical medication scheme based on antihypertensive drug-related genomics.In the second part,A total of 240 hospitalized EH patients(from September 2018 to August 2020)were selected and divided into intervention groups(n1=120 cases)and control group(n2=120 cases)according to whether drugs were adjusted based on antihypertensive drug-related gene polymorphism and pharmaceutical care was provided.In the intervention group,antihypertensive drugs were adjusted according to patients’ genetic polymorphism to provide individualized pharmaceutical care based on the recommendation of Chinese Guidelines for Prevention and Treatment of Hypertension(2018 revised edition).The control group received antihypertensive drugs recommended by the guidelines and did not provide pharmaceutical care.To compare the differences of blood pressure decline,blood pressure compliance time,frequency of medication adjustments,occurrence of adverse reactions,discharge blood pressure compliance rate,re-hospitalization rate between the two groups,and to explore the clinical application value of pharmaceutical care based on antihypertensive drug related genomics.Results:1)In genetic analysis,EH patients in the hospital are more sensitive to CCB drug targets,which can be used as the preferred antihypertensive drug based on the experience of antihypertensive drug-related gene polymorphism;ACEI drugs are sensitive to Inoperpi,Reinoply and Midapuri;normal metabolism of ARB drugs,but weak target effect;better target effect on β1 receptor blockers,and there are significant individual differences in metabolic enzyme-related genotypes,with significant differences in distribution between different BMI patients(P<0.05);The reduction of diastolic pressure was weak when diuretics were used,and there were significant differences in genotype distribution between patients of different sexes(P<0.05),which was more effective in female patients.2)There was no significant difference in age,BMI,sex,smoking history,drinking history,combined diseases(coronary heart disease,cerebral infarction,diabetes,stroke,hyperlipidemia),blood biochemical index,SBP,DBP,HR at the time of admission(P>0.05).After establishing individual pharmaceutical service pathways and pharmacy service based on antihypertensive drug-related genomics,the decrease of patients in hospital SBP and DBP was significantly larger than that of the control group(P<0.05)and the decrease of HR was significantly greater than that of the control group(P<0.05).The average hospitalization day in the intervention group and the control group was about 10 days,with no significant difference(P>0.05);the blood pressure standard time in the intervention group was shorter than that of the control group(P<0.05);the number of test drugs in the intervention group is less than the control group(P<0.05);in the analysis of the occurrence of adverse reactions,the ACEI drug-related dry cough in the intervention group was significantly less than the control group(P<0.05),and there was no significant difference in other adverse reactions(P>0.05).At discharge,SBP,DBP,and HR of the intervention group were significantly lower than those of the control group(P<0.05);the blood pressure compliance rate of the intervention group and the control group was no significant difference(P>0.05).However,the blood pressure compliance rate at 3 and 6 months after discharge in the intervention group was significantly higher than that in the control group(P<0.05).There was no significant difference in the rate of rehospitalization after 3 months of discharge between the two groups(P>0.05),but the rate of rehospitalization after 6 months of discharge in the intervention group was significantly lower than that of the control group(P<0.05).Conclusions:1)For patients without detection of antihypertensive drug-related gene polymorphism,CCB drugs are recommended as the first choice,followed by ARB drugs,and the initial dose of ARB drugs can be used as the maximum effective dose.2)Using diuretic antihypertensive drugs,pay attention to the difference of curative effect between patients of different genders.There are significant differences in the use of β1 receptor blockers for antihypertensive drugs,so note the difference in efficacy between patients with different BMI.3)The antihypertensive drugs were adjusted based on gene polymorphism and the individualized pharmaceutical care provided in combination with the specific condition of patients can significantly improve the blood pressure compliance rate,reduce the times of drug testing and adjustment,reduce the rehospitalization rate and reduce adverse reactions.It is worthy to be widely used in clinical individualized antihypertensive treatment. |
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