Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia.
Clinical Research Centre, Hospital Selayang, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia.
Int J Clin Pharm. 2021 Oct;43(5):1311-1321. doi: 10.1007/s11096-021-01252-z. Epub 2021 Mar 6.
Background Optimum antihypertensive drug effect in chronic kidney disease is important to mitigate disease progression. As frequent adjustments to antihypertensive drugs might lead to problems that may affect their effectiveness, the modifiable factors leading to frequent adjustments of antihypertensive drugs should be identified and addressed. Objective This study aims to identify the factors associated with frequent adjustments to antihypertensive drugs among chronic kidney disease patients receiving routine nephrology care. Setting Nephrology clinics at two Malaysian tertiary hospitals. Method This multi-centre, retrospective cohort study included adult patients under chronic kidney disease clinic follow-up. Demographic data, clinical information, laboratory data and medication characteristics from 2018 to 2020 were collected. Multiple logistic regression was used to identify the factors associated with frequent adjustments to antihypertensive drugs (≥ 1 per year). Main outcome measure Frequent adjustments to antihypertensive drugs. Results From 671 patients included in the study, 219 (32.6%) had frequent adjustments to antihypertensive drugs. Frequent adjustment to antihypertensive drugs was more likely to occur with follow-ups in multiple institutions (adjusted Odds Ratio [aOR] 1.244, 95% confidence interval [CI] 1.012, 1.530), use of traditional/complementary medicine (aOR 2.058, 95% CI 1.058, 4.001), poor medication adherence (aOR 1.563, 95% CI 1.037, 2.357), change in estimated glomerular filtration rate (aOR 0.970, 95% CI 0.951, 0.990), and albuminuria categories A2 (aOR 2.173, 95% CI 1.311, 3.603) and A3 (aOR 2.117, 95% CI 1.349, 3.322), after controlling for confounding factors. Conclusion This work highlights the importance of close monitoring of patients requiring initial adjustments to antihypertensive drugs. Antihypertensive drug adjustments may indicate events that could contribute to poorer outcomes in the future.
慢性肾脏病患者的最佳降压药物效果对于减轻疾病进展非常重要。由于频繁调整降压药物可能会导致影响其疗效的问题，因此应确定并解决导致频繁调整降压药物的可调节因素。
本研究旨在确定在接受常规肾病学护理的慢性肾脏病患者中，与降压药物频繁调整相关的因素。
两家马来西亚三级医院的肾病科诊所。
这是一项多中心、回顾性队列研究，纳入了在慢性肾脏病诊所接受随访的成年患者。收集了 2018 年至 2020 年的人口统计学数据、临床信息、实验室数据和药物特征。使用多变量逻辑回归来确定与降压药物频繁调整（≥1 次/年）相关的因素。
降压药物频繁调整。
在纳入的 671 名患者中，有 219 名（32.6%）降压药物调整频繁。与降压药物频繁调整更相关的因素包括：在多个机构进行随访（调整后的优势比 [aOR] 1.244，95%置信区间 [CI] 1.012，1.530）、使用传统/补充医学（aOR 2.058，95% CI 1.058，4.001）、药物依从性差（aOR 1.563，95% CI 1.037，2.357）、估算肾小球滤过率变化（aOR 0.970，95% CI 0.951，0.990）以及白蛋白尿 A2 类别（aOR 2.173，95% CI 1.311，3.603）和 A3 类别（aOR 2.117，95% CI 1.349，3.322），在控制混杂因素后。
本研究强调了密切监测需要初始降压药物调整的患者的重要性。降压药物调整可能表明未来会出现导致预后更差的事件。
