| Part I Situation of blood pressure control rate and its influencing factors of Chinese follow-up hypertensive outpatientsObjective To investigate the situation of blood pressure(BP) control rate and its related factors of follow-up hypertensive outpatients in China.Methods A cross-sectional epidemiological survey was conducted in the departments of cardiology, general internal medicine, hypertension and geriatrics of125tertiary and secondary hospitals in29cities of China from March to May,2011. Five consecutive hypertensive outpatients of each doctor were defined as subjects. A total of4110essential hypertensive outpatients aged≥18years were recruited, which were diagnosed by820doctors. Among them,3706patients were follow-up outpatients. Demographic characteristics, BP control status, concomitant diseases, family history of disease, and drug use information of each subject’s ultimus prescription were recorded.Result1.3706follow-up patients’ mean age was62.3(18.5-105.0) years and mean BP139.7/83.1mmHg.665(17.9%),899(24.3%),805(21.7%),468(12.6%),217(5.9%) and652(17.6%) patients were normal, high normal, grade1, grade2, grade3and isolated systolic hypertensive outpatients, respectively.1376(37.1%),363(9.8%),694(18.7%),390(10.5%),297(8.0%),811(21.9%),217(5.9%),508(13.7%),596(16.1%),395(10.7%) and571(15.4%) patients were complicated with coronary heart disease(CHD), heart failure, left ventricular hypertrophy, stroke, kidney disease, diabetes, peripheral arterial disease, abnormal total cholesterol(TC), abnormal triacylglycerol, abnormal high density lipoprotein cholesterol, abnormal low density lipoprotein cholesterol, respectively.2. Patients with BP<140/90mmHg accounted for42.2%, and patients with BP control(BP of patients concomited with diabetes and kidney was controlled<130/80mmHg, and other general patients<140/90mmHg) accounted for36.1%.3. Multiple logistic regression analysis results showed that after adjusting other factors, higher age, smoke abandon, see a doctor in secondary hospital, conmited with Antilipemic, some specific antihypertensive drug combination for treatment were protective factors, while higher Body mass index(BMI), smoking, complicated with coronary artery disease, kidney, diabetes, abnormal total cholesterol, very high risk stratification of CV were risk factors of BP control. Conclusion BP control rate was higher than previous time, but was still low. As to hypertensive patients, we should recommend health lifestyle, body weight control, to secondary hospital for treatment, positively control and treating cardiovascular events and its risk factors, rational drug use, health education for young patients strength, then kept the BP to normal level depending on the whole society’s effort, increased BP control rate of outpatients and enhanced the quality of life.Part II Analysis of drug use of hypertensive outpatients in secondary and tertiary hospitals in ChinaObjective To explore the drug use of hypertensive outpatients in secondary and tertiary hospitals in China, and the gap between clinical practice and the recommendation of guideline.Methods Study was conducted in the cardiology, general internal medicine, hypertension and geriatrics departments of125tertiary and secondary hospitals in29cities of China from March to May,2011. Five consecutive hypertensive outpatients of each doctor were defined as cases. Data of4110hypertensive patients which were diagnosed by820doctors were collected. Demographic characters, blood pressures, and drug use information of these subjects were recorded.Results.1. Among the4110subjects,404were newly-diagnosed hypertensive patients and3706patients were follow-up hypertensive outpatients.2. Among the newly-diagnosed hypertensive patients,77(19.1%)、245(60.6%)、57(14.1%) and25(6.2%) patients were grade Ⅰ, grade Ⅱ, grade Ⅲ and isolated systolic hypertension, respectively; The treatment rate of the hypertensive patients was98.7%; the mean number of anti-hypertensive agents prescribed per patient was1.31;98.7%of grade Ⅰ hypertensive patients received drug treatment and the mean drug use was1.31;315(78.0%),97(24.0%),48(11.9%),23(5.7%),20(5.0%) and19(4.7%) patients used angiotensin Ⅱ receptor blocker(ARB), calcium channel blocker(CCB), beta-blocker, angiotensin converting enzyme inhibitors blocker(ACEI), diuretic and fixed-dose combination, respectively;293(72.5%) patients were prescribed one agent and ARB was the most prescribed drug class as a monotherapy; two-drug combination was prescribed to72(17.8%) patients and CCB+ARB combination was the most prescribed two-drug combination class; three-drug or over combination was prescribed to29(7.2%) patients and beta-blocker+CCB+ARB combination was the most prescribed three-drug combination;54(14.6%) patients were conmmitted with lipid-lowing drug,74(18.3%) patients with platelet-reducing medicine.3. Among the follow-up patients, the treatment rate of the follow-up hypertensive patients was98.9%and the mean drug-using number of each patient was1.81;2190(59.1%),1926(52.0%),1271(34.3%),539(14.5%),396(10.7%) and250(6.8%) patients used ARB, CCB, beta-blocker, ACEI, diuretic and fixed-dose combination, respectively;1420(38.3%) patients were prescribed one agent and ARB was the most prescribed drug class as a monotherapy; two-drug combination was prescribed to1592(43.0%) patients and CCB+ARB combination was the most prescribed two-drug combination; three-drug or over combination was prescribed to653(17.6%) patients and beta-blocker+CCB+ARB combination was the most prescribed three-drug combination;1554(41.9%) patients were conmmitted with lipid-lowing drug,1974(53.3%) patients with platelet-reducing medicine; to compare with the last anti-hypertensive medication,1363(36.8%) patients adjusted the medication, and the major styles were "changing the drug class" or "adding drug class";1689(45.6%) patients did not adjust their medication, and the most important reason was "blood pressure control level can be accepted at present".4.837patients were complicated with Diabetes, and105(12.5%) patients’blood pressure was under130/80mmHg; The treatment rate of the hypertensive patients was98.9%;515(61.5%),505(60.3%),308(36.8%),140(16.7%),105(12.5%) and63(7.5%) patients used CCB, ARB, beta-blocker, ACEI, diuretic and fixed-dose combination, respectively, among which632(75.5%) patients used ARB or ACEI drug;238(28.4%) patients were prescribed one agent and ARB was the most prescribed drug class as a monotherapy; two-drug combination was prescribed to388(46.3%) patients and CCB+ARB combination was the most prescribed two-drug combination; three-drug or over combination was prescribed to202(24.2%) patients and beta-blocker+CCB+ARB combination was the most prescribed three-drug combination.5.301patients were complicated with kidney disease, and39(12.9%) patients’blood pressure was under130/80mmHg; The treatment rate of the hypertensive patients was98.7%;195(64.8%),176(58.5%),111(36.9%),49(16.3%),50(16.6%) and16(5.3%) patients used CCB, ARB, beta-blocker, ACEI, diuretic and fixed-dose combination, respectively, among which214(71.1%) patients used ARB or ACEI drug; 93(30.9%) patients were prescribed one agent and ARB was the most prescribed drug class as a monotherapy; two-drug combination was prescribed to126(41.9%) patients and CCB+ARB combination was the most prescribed two-drug combination; three-drug or over combination was prescribed to78(25.9%) patients and beta-blocker+CCB+ARB combination was the most prescribed three-drug combination.Conclusions The newly-diagnosed hypertensive patients mainly receive monotherapy and follow-up patients mostly were gived monotherapy and two-drug combination treatment. ARB and CCB were the most prescribed drugs, while diuretic was rarely used. There was a certain gap between their medication pattern and the requirement of "2010Chinese guideline for the management of hypertension", and unreasonable drug use is in existence. The promotion of guideline should be continued. Rational drug use should be encouraged based on promoting healthy lifestyle. |
PDF Full Text Request