Václavík Jan, Vysočanová Petra, Seidlerová Jitka, Zajíček Petr, Petrák Ondřej, Dlask Jaroslav, Krýza Jiří
From the Department of Internal Medicine I-Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic (JV); Department of Internal Cardiology Medicine, University Hospital Brno, Brno, Czech Republic (PV); Department of Internal Medicine II, Faculty of Medicine in Pilsen, Charles University, Czech Republic (JS); Department of Internal Medicine, Valašské Meziříčí Hospital, Valašské Meziříčí, Czech Republic (PZ); Third Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic (OP); Boehringer Ingelheim Czech Republic (JD); and Cegedim CZ, Czech Republic (JK).
Medicine (Baltimore). 2014 Dec;93(27):e168. doi: 10.1097/MD.0000000000000168.
To improve blood pressure (BP) control of their patients, physicians either adjust or switch antihypertensive medication. Currently, there is only limited information available on why physicians decide to switch antihypertensive medications. A questionnaire-based survey was performed between November 2011 and March 2012 in the Czech Republic. General practitioners were asked to fill in questionnaires about their hypertensive patients whose antihypertensive medication they were planning to change. These questionnaires recorded data about patient demographic information, cardiovascular risk factors, BP values, and reasons for switching antihypertensive medication. Two hundred eight-six general practitioners surveyed a total of 4341 hypertensive patients. The mean age of the patients was 59.8 years, 68.9% of patients were overweight or obese. Uncontrolled office systolic and diastolic BP >140/90 mm Hg was present in 89.6% and 81.5% of patients, respectively, despite the fact that 49.4% of patients used a combination of 2 or more antihypertensive drugs. The most common reasons for switching medication were insufficient BP control (73.7%), followed by aiming for a better 24-hour effect (38.4%) and increased cardiovascular risk of the patients (37.7%). The major reason for switching antihypertensive treatment in general practice was insufficient BP control. Switching medication because of adverse drug effects is less frequent than reported a decade ago.
为改善患者的血压（BP）控制情况，医生会调整或更换抗高血压药物。目前，关于医生决定更换抗高血压药物的原因，可用信息有限。2011年11月至2012年3月期间在捷克共和国进行了一项基于问卷调查的研究。研究要求全科医生填写关于他们计划更换抗高血压药物的高血压患者的问卷。这些问卷记录了患者的人口统计学信息、心血管危险因素、血压值以及更换抗高血压药物的原因。286名全科医生共调查了4341名高血压患者。患者的平均年龄为59.8岁，68.9%的患者超重或肥胖。尽管49.4%的患者使用了两种或更多种抗高血压药物联合治疗，但仍分别有89.6%和81.5%的患者诊室收缩压和舒张压未得到控制（>140/90 mmHg）。更换药物最常见的原因是血压控制不佳（73.7%），其次是追求更好的24小时疗效（38.4%）和患者心血管风险增加（37.7%）。全科医疗中更换抗高血压治疗的主要原因是血压控制不佳。因药物不良反应而更换药物的情况比十年前报告的要少。
