Aftab Muhammad Tariq, Dharamshi Hasnain Abbas, Faraz Ahmed, Shakeel Saba, Shakeel Osama
College of Medicine, University of Dammam, Dammam, Saudi Arabia.
Karachi Medical and Dental College, Karachi, Pakistan.
Pak J Pharm Sci. 2017 Mar;30(2):415-419.
Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident (CVA). This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded < 6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy (62% versus 38%).The mode of therapy was significantly different (P<0.05) in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on anti-hypertensive and oral hypoglycemic agents. A statistical significant difference (P<0.05) was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on anti-hypertensive and insulin. No statistical significant difference (P>0.05) was seen in any combination (p>0.05). Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents.
药物依从性差会降低药物治疗的临床效果。这可能会带来严重后果，尤其是在使用抗高血压药物时，如脑血管意外（CVA）。本研究旨在探讨糖尿病和非糖尿病患者中抗高血压药物依从性差与CVA之间的关联。2013年6月至2013年12月期间，从卡拉奇一家三级护理医院阿巴西·谢赫德医院急诊科收治的100例CVA患者中进行招募。纳入标准为：确诊为CVA，患有原发性高血压，有患者的治疗记录，患者或法定继承人/继承人同意。排除标准为：继发性高血压、新诊断的原发性高血压患者以及完全依从药物治疗。应用了Morisky药物依从性量表。查阅了治疗记录。平均年龄为62.15岁，男女比例为3:1。药物依从性评分<6分。高血压患者41例，糖尿病合并高血压患者59例。与联合治疗相比，大多数患者采用单一疗法（62%对38%）。两组的治疗方式有显著差异（P<0.05）。分别有45.16%、35.48%、16.12%和3.24%的患者使用ACE抑制剂、钙通道阻滞剂、β受体阻滞剂和其他药物。在21例同时使用抗高血压药物和口服降糖药的患者中，上述药物的使用比例分别为57.14%、33.33%和9.52%。在ACE抑制剂的使用情况上存在统计学显著差异（P<0.05）。同样，在38例同时使用抗高血压药物和胰岛素的患者中，它们的使用比例分别为42.10%、39.47%和18.42%。在任何组合中均未发现统计学显著差异（P>0.05）。因此得出结论，在使用口服降糖药的糖尿病患者中，ACE抑制剂依从性差可能是CVA的一个危险因素。
