Skaer T L, Sclar D A, Robison L M, Chin A, Gill M A, Okamoto M P, Nakahiro R K
College of Pharmacy, Washington State University, Pullman.
Clin Ther. 1993 Jul-Aug;15(4):715-25; discussion 714.
A significant factor in the management of hypertension is the extent to which patients comply with the treatment regimen. A retrospective analysis was undertaken to determine the relationship between antihypertensive formulation, regimen compliance, and the utilization of health care services. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 1000 randomly selected patients initially prescribed one of the following antihypertensive regimens as monotherapy: atenolol once daily, captopril BID, oral clonidine BID, transdermal clonidine once weekly, diltiazem BID, enalapril BID, metoprolol BID, prazosin BID, terazosin once daily, and sustained-release verapamil once daily. Multivariate regression analysis was used to determine the incremental influence of selected demographic characteristics, use of medical services before diagnosis of hypertension, initial antihypertensive medication, medication possession ratio for antihypertensive therapy, and number of maintenance medications for diseases other than hypertension on post-period health care expenditures. The results indicated that patients initially prescribed antihypertensive medication requiring once-daily or once-weekly administration experienced an increased utilization of antihypertensive medication, needed fewer changes in their therapeutic regimen, and far less need for concomitant therapy for blood pressure control compared with those prescribed a BID regimen. Patients in the once-daily or once-weekly groups also used significantly fewer physician, hospital, and laboratory services (P < or = 0.05).
高血压管理中的一个重要因素是患者遵守治疗方案的程度。进行了一项回顾性分析，以确定抗高血压药物配方、方案依从性与医疗服务利用之间的关系。该分析的数据来自南卡罗来纳州医疗补助计划的计算机存档。研究人群包括1000名随机选择的患者，他们最初被开具以下抗高血压方案之一作为单一疗法：阿替洛尔每日一次、卡托普利每日两次、口服可乐定每日两次、透皮可乐定每周一次、地尔硫䓬每日两次、依那普利每日两次、美托洛尔每日两次、哌唑嗪每日两次、特拉唑嗪每日一次以及缓释维拉帕米每日一次。采用多变量回归分析来确定选定的人口统计学特征、高血压诊断前医疗服务的使用情况、初始抗高血压药物、抗高血压治疗的药物持有率以及高血压以外疾病的维持药物数量对后期医疗保健支出的增量影响。结果表明，与开具每日两次方案的患者相比，最初开具需要每日一次或每周一次给药的抗高血压药物的患者抗高血压药物的使用增加，治疗方案的变化较少，并且控制血压所需的联合治疗也少得多。每日一次或每周一次组的患者使用的医生、医院和实验室服务也显著较少（P≤0.05）。
