Antihypertensive Medication Use In High-risk Hypertension Patients

Objective To describe the application of antihypertensive drugs including monotherapy and different patterns of combination therapy in high-risk hypertensive patients.Methods We performed a cross-sectional study in patients aged≥50 years with high-risk hypertension from 123 hospitals in 25 provinces and cities from September 2019 to July2020.Patient characteristics(i.e.age,sex,education level),lifestyle(smoking,alcohol),hypertension,diabetes,dyslipidemia,cardiovascular cerebrovascular diseases,and medical history were collected.Biometric data was collected including blood pressure,height,and weight.For continuous variables that follow a normal distribution,the mean±standard deviation is reported,and the t-test is used for comparison between groups;the percentage of categorical variables is reported,and theχ~2 test is used for comparison between groups.Results A total of 13175 patients with high-risk hypertension were included in the study.The mean age of the patients was(64.7±7.2)years,and mean systolic and diastolic blood pressure were(146.3±11.6)mm Hg,and(81.5±10.5),respectively.The proportions of coronary heart disease,stroke,diabetes,and dyslipidemia were 29.5%,26.8%,38.9%,and37.4%,respectively.Of the patients,18.2%did not receive drug therapy,37.6%were receiving monotherapy,and 44.2%were treated with combination therapy.Of the 10782 receiving antihypertensive medication,the usage rates of monotherapy,two-drug combination,and three-drug combination were 46.0%,38.7%,and 13.5%,respectively.The usage rates of Calcium Channel Blockers(CCB),Angiotensin Receptor Blocker(ARB),β-blockers,Angiotensin Converting Enzyme Inhibitor(ACEI),single-pill combination,and diuretics were 68.9%,32.2%,28.7%,16.3%,9.1%,and 6.7%,respectively.In the monotherapy group,CCB were the most frequently used(63.3%).The usage rate of ARB+CCB was the highest in the two-drug combination(29.9%),and the usage rate of ARB+β-blocker+CCB was the highest in the three-drug combination(36.4%).Among the 3883 patients with hypertension and coronary heart disease,the proportions of drug-free,single-drug therapy,and combination therapy were 18.3%,23.3%,and 58.4%,respectively.The drug treatment of patients with coronary heart disease was mainly CCB,accounting for 61.5%,followed byβ-blockers,accounting for 55.8%.Among the 3528 patients with hypertension and stroke,the proportions of drug-free,single-drug therapy,and combination therapy were 18.9%,42.0%,and 39.1%,respectively.The main drug treatment for patients with stroke was CCB,accounting for 73.9%,followed by ARB,accounting for 28.8%.Among the 5124 patients with hypertension and diabetes,the proportions of no medication,single-drug therapy,and combination therapy were 18.1%,35.7%,and 46.3%,respectively.For patients with diabetes,CCB was the main drug treatment,accounting for 70.5%,followed by ARB,accounting for 34.2%.Among the4927 patients with hypertension and dyslipidemia,the proportions of drug-free,monotherapy and combination therapy were 18.4%,41.1%,and 40.4%,respectively.The drug treatment of patients with dyslipidemia was mainly CCB,accounting for 67.8%,followed by ARB,accounting for 31.0%.Conclusion About one-fifth of patients with high-risk hypertension did not receive antihypertensive drugs,and less than half of the patients received combined therapy.CCB and ARB are commonly used antihypertensive drugs in clinical practice.The medications of patients basically meet the recommendations of the guidelines,but some patients still do not recommend medications in accordance with the guidelines.It is still necessary to continue to promote the guidelines,strengthen publicity and education,improve patient drug compliance,and gradually improve the effect of hypertension management.