尼日利亚西南部一家三级医疗机构中医师开具抗高血压联合用药的情况。

Physicians' prescribing of anti-hypertensive combinations in a tertiary care setting in southwestern Nigeria.

作者信息

Yusuff Kazeem B, Balogun Olumide

机构信息

Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.

出版信息

J Pharm Pharm Sci. 2005 Aug 4;8(2):235-42.

PMID:16124935

Abstract

PURPOSE

To evaluate physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria, determine the degree of usage of Angiotensin Converting Enzyme (ACE) inhibitor-based combinations and identify specific points of intervention to improve outcomes of anti-hypertensive combination therapy.

METHODS

A cross-sectional retrospective drug use review was conducted between June 1st and August 31st 2002 using randomly selected 200 case notes of patients attending the Hypertension Clinic at a 900-bed tertiary care facility in southwestern Nigeria. 11 case notes were not used due to incompleteness.

RESULTS

73% (138) of the patients were on anti-hypertensive drug combinations, comprising 71.7% (99), 24.4% (34) and 3.6% (5) on combinations of two, three and four drugs respectively. Overall, Thiazide diuretic consisting mainly of fixed dose combination of Amiloride and Hydorchlorothiazide (Moduretic(r)) was the most frequently prescribed drug class in anti-hypertensive combination therapy (83.3%). ACE inhibitor, Lisinopril (Zestril(r)), was prescribed in combination with Moduretic(r), Calcium channel blocker and beta-blocker in 6.5%, 8.5% and 0.7% respectively. Blood pressure control was adequate in only 29% (40) of patients, though adherence with therapy was documented as adequate in 77.5% (107). Type-2 diabetes mellitus (32.7%) and osteoarthritis (21.8%) were the most frequent co-morbidities. Potentially harmful drug-drug interactions in the study sample were identified in 17.5% (46) of patients. Physician documentation of adverse drug reactions among patients was done in only 10.9% of cases. There appear to be no institutionalised system in place to monitor, detect and document adverse drug reactions among patients on anti-hypertensive drug therapy.

CONCLUSION

Physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria is considerable. However, this practice does not appear to have positively impacted on blood pressure control among hypertensive patients nor being modulated by an Institutionalised standard guide.

摘要

目的

评估尼日利亚西南部一家三级医疗机构中医生开具的抗高血压药物联合处方，确定基于血管紧张素转换酶（ACE）抑制剂的联合用药的使用程度，并确定改善抗高血压联合治疗效果的具体干预点。

方法

2002年6月1日至8月31日期间，对尼日利亚西南部一家拥有900张床位的三级医疗机构高血压门诊随机抽取的200例患者病历进行横断面回顾性药物使用审查。由于不完整，11份病历未被采用。

结果

73%（138例）患者使用抗高血压药物联合治疗，其中分别有71.7%（99例）、24.4%（34例）和3.6%（5例）使用两种、三种和四种药物联合治疗。总体而言，主要由阿米洛利和氢氯噻嗪固定剂量复方制剂（Moduretic(r)）组成的噻嗪类利尿剂是抗高血压联合治疗中最常开具的药物类别（83.3%）。ACE抑制剂赖诺普利（Zestril(r)）分别与Moduretic(r)、钙通道阻滞剂和β受体阻滞剂联合使用的比例为6.5%、8.5%和0.7%。仅29%（40例）患者的血压得到充分控制，尽管记录显示77.5%（107例）患者的治疗依从性良好。2型糖尿病（32.7%）和骨关节炎（21.8%）是最常见的合并症。在17.5%（46例）患者中发现了研究样本中潜在有害的药物相互作用。仅10.9%的病例中医生记录了患者的药物不良反应。似乎没有制度化的系统来监测、检测和记录接受抗高血压药物治疗患者的药物不良反应。