老年高血压患者口服一线降血压药物利用分析:全国多中心研究

Analysis of the Use of the First-line Antihypertensive Agents in Senile Patients with Hypertension: A National Multicenter Study

目的分析2017年全国8个城市老年高血压患者5类一线降血压药物的使用特征,为老年患者合理使用降血压药物提供参考数据。方法基于2017年《医院处方分析合作项目》随机抽取的处方数据,采用药物利用分析方法,对各类降血压药物处方量前5位的药品进行处方数、药品金额和处方日剂量分析。结果共抽取8个城市101家医院处方904296张。男女比例为1.01,中位年龄76岁。钙通道阻滞药(CCB)、β受体阻断药(β-B)和血管紧张素Ⅱ受体拮抗药(ARB)是处方量前3位的降血压药。各类处方量最大的品种(构成比)依次为:氨氯地平(15.85%)、美托洛尔(14.60%)、缬沙坦(6.97%)、螺内酯(3.69%)和培哚普利(2.06%)。中位药品金额最高的品种依次为:氯沙坦(139.16元)、硝苯地平(107.80元)、阿罗洛尔(104.40元)、培哚普利(97.80元)和托拉塞米(36.40元)。血管紧张素转化酶抑制药(ACEI)、ARB和CCB类药物处方日剂量/限定日剂量(PDD/DDD)均值大于1,分别为:1.52,1.42和1.29。合并肾病的患者的5类降血压药PDD/DDD均值高于未合并肾病患者。合并肝病的患者的ACEI、ARB和利尿剂(DU)类降血压药PDD/DDD均值高于未合并肝病患者。结论CCB、β-B和ARB是老年高血压患者最常用的3类降血压药,特别是氨氯地平、美托洛尔和缬沙坦;仍需警惕老年高血压患者降压药物禁忌证,重视合并肾病、肝病患者的药物剂量管理。

Objective To provide reference data for rational use of antihypertensive agents for senile patients,according to the analysis of five first line antihypertensive agents’utilization characteristics for elderly patients in 8 cities in 2017.Methods Based on the prescription data,which was randomly selected from the“2017 Hospital Prescription Analysis Cooperation Project”,the number,amount and daily dose of the top five prescriptions of various antihypertensive drugs were analyzed using a drug utilization analysis method.Results A total of 904296 prescriptions were obtained from 101 hospitals in 8 cities.The ratio of male to female was 1.01.The median age was 76 years old.CCB,β-B and ARB were the top 3 antihypertensive agent types.The largest prescriptions of each type were amlodipine(15.85%),metoprolol(14.60%),valsartan(6.97%),spironolactone(3.69%)and perindopril(2.06%).The highest median costs per prescription for each kind of agents were losartan(139.16 yuan),nifedipine(107.80 yuan),arolol(104.40 yuan),perindopril(97.80 yuan)and tolasemide(36.40 yuan).The mean PDD/DDD value of ACEI,ARB and CCB was greater than 1,with the values of 1.52,1.42 and 1.29,respectively.The PDD/DDD values of the 5 types of agents for patients with renal complications were higher than those for patients without complications,and the PDD/DDD values of ACEI,ARB and DU for patients with liver complications were higher than those for patients without complications.Conclusion CCB,β-B and ARB were the three most commonly used antihypertensive agent types in senile hypertension,especially amlodipine,metoprolol and valsartan.It is still necessary to pay attention to the contraindication of antihypertensive drugs in elderly patients with hypertension,and pay more attention to the drug dosage management in patients with kidney and liver disease.