医院门诊抗高血压药物应用现况研究

Outpatient use status of anti-hypertensive agents

目的调查首都医科大学附属北京安贞医院门诊抗高血压药物的应用现况。方法回顾性调查2015年5—12月首都医科大学附属北京安贞医院门诊高血压患者的就诊信息;筛选出北京市医疗保险、本院门诊就诊次数>1且研究期间抗高血压药物治疗方案不变的处方187 047张,涉及患者14 768例。按照就诊科室进行分组,分为全科医疗科、心内科、高血压科、其他科,汇总各科室抗高血压药物治疗方案的处方数,并分析二联用药指南推荐方案的应用情况。结果筛选出的187 047张处方中,单一用药处方数为92 423张(49.4%),联合用药处方数为94 624张(50.6%)。高血压科的联合用药占比明显高于全科医疗科、心内科和其他科[69.6%(34 117/48 985)比45.8%(20 582/44 961)、45.1%(23 703/52 612)、40.1%(16 222/40 489)](均P<0.05)。高血压科的复方制剂应用占比明显高于全科医疗科、心内科和其他科[49.2%(16 785/34 117)比42.0%(8 647/20 582)、39.5%(9 361/23 703)、31.6%(5 132/16 222)](均P<0.05)。高血压科的二联用药指南推荐方案应用占比明显高于其他各科[80.5%(10 211/12 689)比76.7%(7 700/10 037)、76.8%(9 366/12 199)、75.6%(7 103/9 398)](均P<0.05);各科室均以钙离子拮抗剂+血管紧张素Ⅱ受体拮抗剂方案为主。结论我院门诊高血压患者药物治疗方案以联合用药为主。高血压科门诊在二联用药方案的选择上较全科医疗科、心内科和其他科更符合指南推荐。

Objective To investigate the use status of anti-hypertensive drugs in outpatients. Methods A retrospective study was conducted in Beijing Anzhen Hospital, Capital Medical University from May to December 2015. Totally 187 047 medical prescriptions of constant anti-hypertensive regimens in 14 768 hypertensive outpatients with Beijing medical insurance and more than 1 time of visiting were included. The prescriptions of anti-hypertensive drugs were analyzed among departments of general medical practice, cardiology, hypertension and other subjects; the application status of dual-drug regimens which were recommended in guidelines was analyzed. Results In 187 047 prescriptions, single-drug regimen accounted for 92 423 （49.4%）, and drug combination accounted for 94 624 （50.6%）. Drug combination rate in hypertension department was significantly higher than that in general medical practice, cardiology and other departments [ 69. 6% （34 117/48 985 ） vs 45. 8% （20 582/44 961 ）, 45. 1% （23 703/52 612）, 40. 1% （ 16 222/40 489） ] （P 〈 0. 05 ）. Compound preparation use rate in hypertension department was significantly higher than that in general medical practice, cardiology and other departments[ 49. 2% （ 16 785/34 117） vs 42. 0% （ 8 647/20 582）, 39. 5% （9 361/23 703）, 31.6% （5 132/16 222） ] （P 〈0.05）. Use rate of dual-drug recommended in guidelines in hypertension department was significandy higher than that. in general medical practice, cardiology and other departments[ 80. 5% （10 211/12 689） vs 76. 7% （7 700/10 037）, 76.8% （9 366/12 199）, 75.6% （7 103/9 398）] （P 〈 0. 05）, and the regimen of calcium channel blockers ＋ angiotensin receptor antagonists was the most widely used. Conclusions Drug combination is the predominant therapeutic regimen for hypertensive patients. Outpatient use status of anti-hypertensive agents in department of hypertension is acceptable in accordance with guidelines.