Etuk E, Isezuo S A, Chika A, Akuche J, Ali M
Department of Pharmacology, College of Health Sciences Usmanu DanFodiyo University, Sokoto, Nigeria.
Ann Afr Med. 2008 Sep;7(3):128-32. doi: 10.4103/1596-3519.55665.
This study examined the pattern of physicians' prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians' compliance with recommended guidelines.
Records of 145 patients aged 17-91 (mean: 52.6+/-14.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and 90 mmHg, respectively.
Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and 4 drugs, respectively. Diuretic was the most frequently p rescribed drug either as a single agent (44.8%) or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were more in patients on calcium channel blocker than those on diuretic monotherapy (t=2.5 and 3.6 for reductions in systolic and diastolic BP, respectively; P<.05 for both), and, in patients on combination therapy than those on monotherapy (t=3.64 and 3.27 for reductions in systolic and diastolic BP, respectively; P<.01 for both). Blood pressure control rate was 30.5%.
Our results are consistent with the previously observed benefits of antihypertensive combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major limitations of this work include its retrospective nature and the inability to determine the actual patients' adherence to therapy.
本研究探讨了医生开具抗高血压药物的模式及其对血压控制的可能影响，以及医生对推荐指南的遵循情况。
随机选取145例年龄在17 - 91岁（平均52.6±14.6岁）的患者记录，男女比例为1:1.2。记录抗高血压处方信息。血压控制定义为收缩压和舒张压分别低于140 mmHg和90 mmHg。
在研究的145例患者中，20%（29例）接受单药治疗，80%（116例）接受联合治疗。在接受联合治疗的患者中，分别有61.2%（71例）、33.6%（39例）和5.2%（6例）使用2种、3种和4种药物。利尿剂是最常开具的药物，无论是作为单一药物（44.8%）还是联合治疗（88.8%）。使用钙通道阻滞剂的患者收缩压和舒张压的平均降低幅度均大于使用利尿剂单药治疗的患者（收缩压和舒张压降低幅度的t值分别为2.5和3.6；两者P均<0.05），且联合治疗患者的收缩压和舒张压降低幅度大于单药治疗患者（收缩压和舒张压降低幅度的t值分别为3.64和3.27；两者P均<0.01）。血压控制率为30.5%。
我们的结果与先前观察到的抗高血压联合治疗的益处一致，并表明在研究人群中，钙通道阻滞剂单药治疗在降低血压方面明显比利尿剂单药治疗更有效。这项工作的主要局限性包括其回顾性性质以及无法确定患者实际的治疗依从性。
