Saadeh Rawan, Qato Dima, Khader Ali, Shahin Yousef, Seita Akihiro
Health Department, United Nations Relief and Works Agency Headquarters, Bayader Wadi Seer, 11814, Amman Jordan.
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, 833 South Wood Street, Chicago, Illinois USA.
J Pharm Policy Pract. 2015 May 18;8(1):17. doi: 10.1186/s40545-015-0036-4. eCollection 2015.
The purpose of this study is to describe trends in the utilization of antihypertensive medications, overall and by type of medication, specifically thiazide diuretics, as well as uncontrolled hypertension, in the Palestine refugee population in Jordan between 2008 and 2012.
We analyzed aggregate procurement data on antihypertensive medications derived from the United Nations Relief and Works Agency (UNRWA) pharmacy records between 2008 and 2012. Antihypertensive medications were aggregated and utilization was calculated overall and for specific types of antihypertensive medications (e.g. β-blockers, diuretics). We used the WHO (World Health Organization) defined daily dose (DDD) methodology, often used to evaluate drug utilization patterns using aggregate data, to calculate utilization defined as DDDs per 100 persons with hypertension. In addition, UNRWA medical records were used to measure the prevalence of uncontrolled hypertension in the primary care setting. Uncontrolled hypertension was defined as a systolic/diastolic blood pressure ≥140/90 in at least 2 out of 3 readings, one of which is the most recent reading, during the year for a patient diagnosed with hypertension.
Overall, total utilization of antihypertensive medications has not changed between 2008 and 2012; hypertensive patients persistently used at least 2 antihypertensive medications daily (range 200-280 DDDs/100 patients with hypertension) during this five-year period. However, there is significant variation in utilization patterns by type of antihypertensive medication. While Angiotensin Converting Enzyme Inhibitors (ACE-I) were persistently the most commonly used antihypertensive medication, there utilization significantly (P < 0.05) declined by 26%. However, there was a statistically significant increase of 124% in the utilization of thiazide diuretics. Further, the prevalence of uncontrolled hypertension has also declined at a rate of 3% annually between 2008 and 2012.
Our findings indicate that the STGs for hypertension management implemented in 2009 as part of UNRWA's essential drug program have increased the utilization of thiazide diuretics, and potentially contributed to improvements in hypertension control. This study also demonstrates that feasibility of drug utilization studies in monitoring and evaluating trends in the use of essential medications in low-resource settings.
本研究旨在描述2008年至2012年期间约旦巴勒斯坦难民人群中抗高血压药物的总体使用趋势、按药物类型（特别是噻嗪类利尿剂）划分的使用趋势以及未控制的高血压情况。
我们分析了2008年至2012年期间源自联合国近东巴勒斯坦难民救济和工程处（近东救济工程处）药房记录的抗高血压药物采购汇总数据。对抗高血压药物进行汇总，并计算总体及特定类型抗高血压药物（如β受体阻滞剂、利尿剂）的使用情况。我们采用世界卫生组织（WHO）定义的每日剂量（DDD）方法（该方法常用于利用汇总数据评估药物使用模式）来计算使用情况，定义为每100名高血压患者的DDD数。此外，近东救济工程处的医疗记录用于衡量初级保健机构中未控制高血压的患病率。未控制高血压定义为在一年内，对于确诊为高血压的患者，在三次测量中至少有两次（其中一次为最近一次测量）收缩压/舒张压≥140/90。
总体而言，2008年至2012年期间抗高血压药物的总使用量没有变化；在这五年期间，高血压患者持续每日至少使用两种抗高血压药物（范围为200 - 280 DDDs/100名高血压患者）。然而，抗高血压药物类型的使用模式存在显著差异。虽然血管紧张素转换酶抑制剂（ACE-I）一直是最常用的抗高血压药物，但其使用量显著下降（P < 0.05），降幅为26%。然而，噻嗪类利尿剂的使用量在统计学上显著增加了124%。此外，2008年至2012年期间未控制高血压的患病率也以每年3%的速度下降。
我们的研究结果表明，2009年作为近东救济工程处基本药物计划一部分实施的高血压管理标准治疗指南增加了噻嗪类利尿剂的使用，并可能有助于改善高血压控制。本研究还证明了药物使用研究在监测和评估资源匮乏地区基本药物使用趋势方面的可行性。
