Investigation of drug use in essential hypertension patients with or without cardiovascular comorbidity

Year 2020, Volume: 34 Issue: 2, 117 - 130, 31.08.2020

Dilara Bayram Volkan Aydın Orkun Celil Sel Ali Serdar Fak , Mehmet Akman , Zehra Aysun Altıkardeş , Ahmet Akıcı

https://doi.org/10.5505/deutfd.2020.05900

Abstract

INTRODUCTION: Comorbidities are common in hypertension (HT) and determine management of antihypertensive therapy. We aimed to investigate drug utilization in hypertensive patients based on the presence of other cardiovascular problems.
METHODS: This retrospective study included data of patients applied to the Turkish Heart Foundation Medical Center between January 2016-June 2018 (n=11.085). Among all medical records (n=26.699), medications, medical and demographic characteristics were evaluated in patients with most common diagnosis: HT, ischemic heart disease (IHD), and dyslipidemia (DL). Data for HT and accompanying IHD and DL were compared.
RESULTS: 22.2% (n=5929) of the visits had diagnosis of HT. Of the total 3601 HT patients, 43.7% (n=1572) had single diagnosis and 36.7% (n=1321) had at least one of the two comorbidities. Acetylsalicylic acid was the most common drug in all groups. The most common antihypertensive group was renin-angiotensin system (RAS) blockers and the active molecules were metoprolol and amlodipine. This was followed by “valsartan+hydrochlorothiazide” in HT alone or HT+DL groups and by ramipril in the groups where IHD accompanied. The use of beta-blockers was lower in patients ≥65 years compared to younger patients (13.8% and 16.1%, respectively, p<0.05).
DISCUSSION AND CONCLUSION: In this study, the most preferred antihypertensive group was drugs acting on RAS, dominated by angiotensin receptor blockers and most preferred drug was metoprolol. Contrary to their comparably deprioritization in recent guidelines, beta-blockers seem to be widely used in this setting. It is understood that the most commonly used drugs do not vary overall in the studied comorbidities of HT.

Keywords

drug utilization, antihypertensive agents, ischemic heart disease, dyslipidemia

Kardiyovasküler komorbiditesi bulunan ve bulunmayan esansiyel hipertansiyon hastalarında ilaç kullanımının araştırılması

Abstract

GİRİŞ ve AMAÇ: Hipertansiyon, komorbiditesi sık bir hastalık olup bu durum tedaviyi düzenlenmede belirleyicidir. Bu çalışmada hipertansif hastalarda başka kardiyovasküler problemin olup olmama durumuna göre ilaç kullanımının incelenmesi amaçlandı.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya Türk Kalp Vakfı Tıp Merkezi’nin Ocak 2016-Haziran 2018 arasındaki hasta verileri dahil edildi (n=11.085). Hastalara ait kayıtlı tanılar içerisinde (n=26.699) en sık karşılaşılan üç tanı olan hipertansiyon (HT), iskemik kalp hastalığı (İKH) ve dislipidemi (DL) bulunanların tedavilerindeki ilaçları, tıbbi ve demografik özellikleri değerlendirildi. HT verileri ile buna eşlik eden İKH ve DL verileri karşılaştırıldı.
BULGULAR: Çalışma periyodunda oluşturulan protokollerin %22,2’sini (n=5929) HT oluşturmaktaydı. Toplam 3601 HT tanılı hastanın %43,7’sini (n=1572) tek tanılı olanlar, %36,7’sini ise (n=1321) eşlik eden iki komorbiditenin en az birini içeren hastalar oluşturuyordu. İncelenen tüm tanı gruplarında en sık karşılaşılan ilaç asetilsalisilik asit idi. En sık karşılaşılan antihipertansif ana ilaç grubu renin-anjiyotensin sistemi (RAS) blokerleri, etkin maddeler ise metoprolol ve amlodipin idi. Bunu tek başına HT ve HT’ye DL’nin eşlik ettiği grupta “valsartan+hidroklorotiyazid”, İKH’nin eşlik ettiği gruplarda ramipril izliyordu. Beta-bloker kullanımı ≥65 yaş hastalarda genç hastalara kıyasla daha düşüktü (sırasıyla %13,8 ve %16,1, p<0,05).
TARTIŞMA ve SONUÇ: Bu çalışmada en çok tercih edilen antihipertansif grubun, anjiyotensin reseptör blokerlerinin baskınlığında, RAS üzerinden etkililer, en çok tercih edilen ilacın ise metoprolol olduğu göze çarpmaktadır. Son yıllardaki kılavuzlarda beta-bloker kullanımının nispeten geri plana düşmüş olmasına rağmen, bu çalışmada hipertansif hastalarda yaygın olarak kullanıldığı görülmektedir. HT’ye eşlik eden iki durumda da en sık kullanılan ilaçların genel olarak değişkenlik göstermediği anlaşılmaktadır.

Keywords

ilaç kullanımı, antihipertansif ajanlar, iskemik kalp hastalığı, dislipidemi

References

• GBD 2017 Cause of Death Collaborators. Global, regional, and national age-specific and sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88.
• Özdemir R, Horasan GD, Rao C, Sözmen MK, Ünal B. An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey. Public Health. 2017;151:121-30.
• Kjeldsen SE. Hypertension and cardiovascular risk: General aspects. Pharmacol Res. 2018;129:95-9.
• Jarari N, Rao N, Peela JR, Ellafi KA, Shakila S, Said AR, et al. A review on prescribing patterns of antihypertensive drugs. Clin Hypertens. 2016;22:7.
• Semark B, Engström S, Brudin L, Tågerud S, Fredlund K, Borgquist L, et al. Factors influencing the prescription of drugs of different price levels. Pharmacoepidemiol Drug Saf. 2013;22:286-93.
• Kılıçkap M, Barçın C, Göksülük H, Karaaslan D, Özer N, Kayıkçıoğlu M, et al. Data on prevalence of hypertension and blood pressure in Turkey: Systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors. Turk Kardiyol Dern Ars. 2018;46:525-45.
• Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441-50.
• Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, et al. European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels. [Erisim tarihi: 09 Haziran 2020]. Erisim adresi: http://www.ehnheart.org/images/CVD-statistics-report-August-2017.pdf.
• Otsuka T, Takada H, Nishiyama Y, Kodani E, Saiki Y, Kato K, et al. Dyslipidemia and the risk of developing hypertension in a working-age male population. J Am Heart Assoc. 2016;5(3):e003053.
• Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens. 2016;34:1208-17.
• Bayram F, Kocer D, Gundogan K, Kaya A, Demir O, Coskun R, et al. Prevalence of dyslipidemia and associated risk factors in Turkish adults. J Clin Lipidol. 2014;8:206-16.
• Scholes S, Mindell JS. Health Survey for England 2017 Cardiovascular diseases. National Health Service (NHS). December 2018. [Digital] ISBN: 978-1-78734-255-2. [Erisim tarihi: 09 Haziran 2020]. Erisim adresi: http: //healthsurvey.hscic.gov.uk/media/78646/HSE17-CVD-rep.pdf
• Tran J, Norton R, Conrad N, Rahimian F, Canoy D, Nazarzadeh M, et al. Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study. PLoS Med. 2018;15(3):e1002513.
• Murphy MO, Loria AS. Sex-specific effects of stress on metabolic and cardiovascular disease: Are women at higher risk? Am J Physiol Regul Integr Comp Physiol. 2017;313:R1–R9.
• Chronic diseases and risk factors survey in Turkey. Republic of Turkey Ministry of Health. Publication No: 909 Ankara, 2013.
• Gomez DM, Castillon PG, Fresnillo SH, Banegas JR, Sadarangani KP, Artalejo FR. A healthy lifestyle attenuates the effect of polypharmacy on total and cardiovascular mortality: A national prospective cohort study. Sci Rep. 2018;8:12615.
• Morgado MP, Rolo SA, Pereira L, Branco MC. Blood pressure control and antihypertensive pharmacotherapy patterns in a hypertensive population of Eastern Central Region of Portugal. BMC Health Serv Res. 2010;10:349.
• Arıcı M, Birdane A, Güler K, Yıldız BO, Altun B, Ertürk Ş, ve ark. Türk hipertansiyon uzlaşı raporu. Arch Turk Soc Cardiol. 2015;43:402–9.
• Gupta M, Szmitko PE, Kajil M, Ostrovksi I, Tsigoulis M, Verma S, et al. Acetylsalicylic acid use in primary prevention in Canada: Insight from the primary care audit of global risk management (PARADIGM) study. Curr Res Cardiol. 2016;3:67-70.
• Solanki KC, Mistry RA, Singh AP, Jadav SP, Patel NM, Trivedi HR. Drug utilization study of anti-hypertensive drugs and their adverse effects in patients of a tertiary care hospital. J ClinExp Res. 2013;1:58-67
• Eshiet UI, Yusuff KB. Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: A probable shift of paradigm. Pharm Pract (Granada). 2014;12:419.
• McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379:1509-18.
• Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomised, double-blind, placebo-controlled trial. Lancet. 2018;392:1036-46.
• Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: The National Health And Nutrition Examination Survey, 2001 to 2010. Circulation 2012;126:2105-14.
• Narayan SW, Nishtala PS. Antihypertensive medicines utilization: A decade-long nationwide study of octogenarians, nonagenarians and centenarians. Geriatr Gerontol Int. 2017;17:1109-17.
• Sundbøll J, Adelborg K, Mansfield KE, Tomlinson LA, Schmidt M. Seventeen-year nationwide trends in antihypertensive drug use in Denmark. Am J Cardiol. 2017;120:2193-200.
• Vark LCV, Bertrand M, Akkerhuis KM, Brugts JJ, Fox K, Mourad JJ, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: A meta-analysis of randomized clinical trials of renin–angiotensin–aldosterone system inhibitors involving 158 998 patients. Eur Heart J. 2012;33:2088–97.
• Caldeira D, David C, Sampaio C. Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors. A systematic review and meta-analysis. Am J Cardiovasc Drugs. 2012;12:263-77.
• Messerli FH, Bangalore S, Bavishi C, Rimoldi SF. Angiotensin-converting enzyme inhibitors in hypertension: To Use or Not to Use? J Am Coll Cardiol. 2018;71:1474-82.
• Li EC, Heran BS, Wright JM. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension. Cochrane Database Syst Rev. 2014;2014:CD009096.
• Omboni S, Volpe M. Angiotensin receptor blockers versus angiotensin converting enzyme inhibitors for the treatment of arterial hypertension and the role of olmesartan. Adv Ther. 2019;36:278-97.
• Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–248.
• Dezsi CA, Szentes V. The real role of beta-blockers in daily cardiovascular therapy. Am J Cardiovasc Drugs. 2017;17:361-73.
• Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104.
• Egan B, Flack J, Patel M, Lombera S. Insights on beta-blockers for the treatment of hypertension: A survey of health care practitioners. J Clin Hypertens (Greenwich). 2018;20:1464-72.
• Ham AC, van Dijk SC, Swart KMA, Enneman AW, van der Zwaluw NL, Brouwer-Brolsma EM, et al. Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis. Br J Clin Pharmacol. 2017;83:2292-302.
• Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: A meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393:407-15.
• Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63:2889–934.
• Walley T, Folino-Gallo P, Stephens P, Van Ganse E. Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997–2003. Br J Clin Pharmacol. 2005;60:543-51.
• Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13:55-9.
• Suh S, Kim DK. Subclinical hypothyroidism and cardiovascular disease. Endocrinol Metab. 2015;30:246-51.
• Özgül Ö, Şahin S, Cander S, Gül B, Ünal OK, Akçalı Ü, ve ark. Endokrinoloji polikliniğine başvuran hastalarda tiroid fonksiyonlarının yaş ile olan ilişkisinin incelenmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2011;37:67–70.
• Sarıtaş A, Sarıtaş PU, Kurnaz MM, Çelik A. Spectrum and Prevalence of Thyroid Disorders in Patients Admitted to the Anaesthesiology Outpatient Clinic for Surgery. Turk J Anaesthesiol Reanim. 2015;43:240-5.
• Wouters OJ, Kanavos PG, McKee M. Comparing generic drug markets in Europe and the United States: Prices, volumes, and spending. Milbank Q. 2017;95(3):554-601. T.C. Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2017 Haber Bülteni. Sayı: 6. Ankara; 2018. [Erişim tarihi: 10 Mayıs 2020]. Erişim adresi: https://dosyamerkez.saglik.gov.tr/Eklenti/27344,saglik-istatistikleri-yilligi-2017-haber-bultenipdf.pdf?0
• Kesselheim AS, Misono AS, Lee JL, Stedman MR, Brookhart MA, Choudhry NK, et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: A systematic review and meta-analysis. JAMA. 2008;300:2514-26.