Analysis Of Related Factors And Prescription Drugs For Hypertensive Patients In A Tertiary Hospital In Shanxi Province

Background:Hypertension is a clinical syndrome characterized by increased systemic arterial pressure,or accompanied by functional or organic damage of heart,brain,kidney and other organs,which is one of the most common chronic diseases in clinical and even daily life,and is also the most important risk factor for cardiovascular and cerebrovascular diseases,which seriously threatens human health.At present,there are more than 260 million hypertensive patients in China,and if hypertensive patients do not carry out rational drug intervention in time,it may cause complications such as hyperglycemia,hyperlipidemia,coronary heart disease and so on.However,the awareness rate of hypertensive patients is only 42.6%.Effective control of blood pressure depends on the rational use of antihypertensive drugs clinically,and environmental and lifestyle habits also have an impact on blood pressure.Therefore,this study aims to statistically analyze the use of drugs in outpatient hypertension in hospitals,the use of traditional Chinese medicine（TCM）by inpatients with hypertension,the influence of air quality,monthly temperature difference and other factors on the number of hypertensive patients,find out the problems existing in the current treatment of hypertension,and put forward corresponding suggestions for irrational drug use,and put forward corresponding countermeasures for the influence of air quality and monthly temperature difference on the blood pressure of hypertensive patients.In order to improve the clinical rational drug use level of hypertensive patients and guide hypertensive patients how to do a good job of personal protection when air quality and monthly temperature difference change,it is of great practical significance.Objective:In this study,a retrospective analysis method was proposed to statistically analyze the medication use of outpatient hypertension patients in the cardiovascular department and the use of TCM in patients with inpatient hypertension in the department of TCM of a tertiary hospital in Shanxi Province,investigate the effects of air quality and monthly temperature difference on the number of hypertensive patients,and find that the irrational medication use in the current hypertension treatment process and the influence of air quality and monthly temperature difference on the number of hypertensive patients.In addition,corresponding suggestions and solutions are put forward for the irrational use of drugs and the impact of air quality and monthly temperature difference on hypertensive patients,so as to provide a gist for rational drug use by hypertensive patients in medical institutions and guid hypertensive patients how to do a good job in personal protection when air quality and monthly temperature difference change,provide a reference gist for the optimization and improvement of the"rational drug use pre-review system"of medical institutions,and standardize the prescription behavior of medical staff.Improve the rational drug use level of hypertension in general hospitals in northern China,and provide reliable and representative reference data.Methods:First,the gender,age,department,clinical diagnosis,date of visit,generic name,specification,quantity,unit price,usage,dosage and other information in the prescriptions of outpatients with hypertensive in the cardiovascular department from November 1,2018 to October 31,2019 were collected through the hospital prescription audit center.Collect historical data of air quality index in the corresponding local time period,including date,monthly temperature difference,air quality level,air quality index（AQI）and its indicators including fine particulate mater（PM2.5）,inhalable particles（PM10）,sulfur dioxide（SO₂）,cabon oxide（CO）,nitrogen dioxide（NO₂）,eight hours of ozone（O₃-8h）;From January 2022 to June 2022,the gender,age,date of hospitalization,TCM diagnosis,main symptoms,modern medical diagnosis comorbidities,medical index values of inpatients with hypertension hospitalized in the Department of TCM in a tertiary hospital in Shanxi Province were collected,the diagnosis of TCM,tongue pulse,the principles of TCM treatment,the composition of the medicinal flavor of TCM,the dosage,and the signs at discharge.Excel and SPSS were used to collect the epidemiological characteristics of outpatient hypertension patients,the use of antihypertensive drugs in outpatient hypertension patients,the use of over-the-counter drugs in hypertensive patients and the use of TCM in inpatients with hypertensive.Analyze and statistically unreasonable drug use,medication frequency（DDDs）,daily average cost（DDDc）,drug utilization index（DUI）,unreasonable types of prescription for outpatient hypertension,and use of TCM by patients with inpatient hypertension.Results:（1）There were 5585 patients diagnosed with hypertension in the outpatient cardiovascular department,including 2733 men,accounting for 48.93%,and 2852 women,accounting for 51.07%,which was slightly higher than that of men.In this study,the number of hypertension patients of different ages and genders was significantly different,and autumn was the high incidence period of hypertension at all ages.There are slightly more men than women with high blood pressure in winter and more women than men in other seasons.October was the highest number of people with hypertension in all age groups,with February being the lowest month.The air pollution indexes were inversely correlated with the number of outpatients with hypertension.Air pollution indicators have a significant impact on the number of people with hypertension,especially female patients are more sensitive to changes in air pollution indicators.There was a moderate correlation between the number of women affected by AQI,PM2.5,PM10 and SO₂（P<0.05,|R|value is between 0.40 to 0.69）,and there was a high correlation with CO index（P<0.05,R=-0.746,|R|value is between 0.70 to 0.89）.（2）This study counted the types of drugs in the prescription of outpatient antihypertensive drugs,mainly divided into calcium channel blockers（CCB）,angiotensinⅡreceptor blockers（ARB）,angiotensin converting enzyme inhibitor（ACEI）,βreceptor blockers,diuretics,αreceptor blockers,fixed compound preparations,and other vasodilators,a total of eight categories,36 drugs.The use of various antihypertensive drugs was the highest proportion of CCB（35.03%）,followed by ARB（25.30%）,ACEI and fixed compound preparations accounted for 12.63%and 12.07%respectively,and the other categories accounted for relatively low.Among hypertension comorbidities,the top three comorbidities are coronary heart disease,hyperlipidemia and cerebrovascular disease.In the treatment of comorbidities,the antihypertensive drugs used were the most used by ARB,accounting for 36.94%.The combination regimen of antihypertensive drugs was mainly dual,with 474 cases,accounting for 84.04%of the total number of combination drug prescriptions,of which 156 cases were CCB+ARB,accounting for 32.91%;The combination of hypertension and other diseases was still dominated by dual drugs,with 334 cases,accounting for 55.39%,of which 39 cases of ARB+statin lipid-lowering drugs,accounting for 11.68%.（3）This study examined DDDs,DDDc,and DUI of various antihypertensive drugs.Among them,the highest DDDs are CCB;The drug with the highest ranking of DDDs was candesartan cilexetil tablets,with a DDD value of 56790;The highest DDDc was amlodipine benzepril tablets,with a DDDc value of 6.71;Except for terazosin hydrochloride capsules and amlodipine bennazepril tablets,the DUI of other antihypertensive drugs was less than or equal to 1.Among the 5585 prescriptions for hypertension surveyed,3541 were unreasonable prescriptions,accounting for 61.95%,and the most unreasonable type of prescription was inappropriate dosage,with 1878 cases,accounting for 53.04%of the total prescriptions.（4）This study examined the use of the drugs in outpatient hypertensive patients and the use of TCM in inpatient hypertensive patients.The most prescriptions for proprietary Chinese medicines were Pu Ginseng capsules,with 225 cases,accounting for 33.14%of the prescriptions of proprietary Chinese medicines.The medicinal flavor composition of proprietary Chinese medicines was the most used as activate blood circulation and dissolve stasis drugs,accounting for 40.51%,followed by tonic drugs and water tongling drugs,accounting for 19.50%and 11.75%respectively.Inappropriate dosage and indications are the main types of prescriptions for irrational prescription of the drugs in patients with hypertension.Systolic blood pressure（SBP）was reduced in 77.78%of hospitalized hypertension patients and diastolic blood pressure（DBP）was reduced in 81.48%of hospitalized hypertension patients after treatment,and the maximum reduction was 54 mm Hg and 31 mm Hg,respectively.During hospitalization,the patient’s body temperature was stable,breathing was stable,and the pulse fluctuates slightly and is within the normal range at discharge.During hospitalization,patients with hypertension had significantly improved their main symptoms such as"poor sleep,limb disadvantage,and neck and back pain";The use of TCM for hospitalized hypertensive patients is divided into three categories:"blood circulation and stasis removal drugs","liver calming and wind removal drugs"and"water and swelling and gonorrhoea drugs",all of which have significant antihypertensive effects.Conclusion:The age and sex distribution of hypertension patients in outpatient cardiovascular department are in line with the epidemiological characteristics of hypertension in China.The number of patients of all ages was the highest in autumn,and the air pollution indicators were inversely correlated with the number of outpatient hypertension.The proportion of antihypertensive drugs used in CCB is the highest,and the proportion of diuretics is relatively low.Among hypertension comorbidities,the top three comorbidities are coronary heart disease,hyperlipidemia and cerebrovascular disease,and ARB is the most commonly used in various comorbidities.The most commonly used regimen for combination is CCB plus other types of antihypertensives.In the regimen of hypertension combined with other diseases,CCB combined with statin lipid-lowering drugs is most commonly used.The highest DDDs of various antihypertensive drugs is CCB,and amlodipine benazepril tablets have the highest DDDc value.The most common types of irrational drug use are inappropriate dosage in different medication schemes;Irrational use of drugs in hospitalized hypertensive patients is rare.This study conducted a comprehensive investigation and analysis of the outpatient prescription information of the tertiary hospital,identified the main problems in outpatient prescription,and provided ideas and basis for medical institutions to improve the relevant systems of rational drug use and health regulatory departments to formulate relevant hospital medication management policies.