沈阳市青年高血压住院患者药物流行病学调查

Antihypertensive medication among young hypertension inpatients in Shenyang city

目的了解辽宁省沈阳市青年高血压住院患者的药物流行病学特征,为评估青年高血压患者的合理用药提供参考依据。方法采用方便抽样方法随机抽取2013年1月—2017年1月沈阳市某3所三级甲等医院心血管内科住院的3000例青年高血压患者的病历资料,分析其药物流行病学特征。结果沈阳市3000例青年高血压住院患者中,1级高血压患者541例(18.03%),2级高血压患者1104例(36.80%),3级高血压患者1355例(45.17%);伴发疾病包括左心室肥厚774例(25.80%),颈动脉硬化252例(8.40%),冠心病452例(15.07%),心力衰竭184例(6.1%),缺血性脑卒中408例(13.60%),出血性脑卒中204例(6.80%),慢性肾脏病160例(5.33%);抗高血压药物单药治疗888例(29.60%),联合用药2112例(70.40%);单药治疗中,血管紧张素转化酶抑制剂(ACEI)184例(20.72%),血管紧张素受体阻断剂(ARB)152例(17.12%),β–受体阻滞剂176例(19.82%),钙通道阻滞剂(CCB)300例(33.78%),利尿剂76例(8.56%),1、2和3级高血压患者降压药物单药使用情况差异有统计学意义(χ2=44.87,P<0.001);联合用药治疗中,ACEI/ARB+CCB 344例(16.29%),ACEI/ARB+利尿剂196例(9.28%),CCB+β–受体阻滞剂352例(16.67%),ACEI/ARB+CCB+利尿剂416例(19.70%),ACEI/ARB+β–受体阻滞剂+CCB556例(26.33%),ACEI/ARB+β–受体阻滞剂+利尿剂248例(11.74%),2和3级高血压患者降压药物使用情况差异有统计学意义(χ2=138.45,P<0.001)。结论沈阳市不同级别青年高血压住院患者的用药类别不同,应针对不同级别高血压患者合理应用降压药物。

Objective To examine antihypertensive medication among young hypertension inpatients in Shenyang city and to provide evidences for rational drug use in young hypertensive patients.Methods Using convenient sampling,we extracted clinical records of 3000 hypertension patients aged 18–45 years and hospitalized in cardiovascular departments of 3 grade A tertiary hospitals in Shenyang city between January 2013 to January 2017.The data on antihypertensive medication of the inpatients were analyzed retrospectively.Results Of the inpatients,18.03%(541),36.80%(1104),and 45.17%(1355)were diagnosed as gradeⅠ,Ⅱ,andⅢhypertension;25.80%(774)were complicated with left ventricular hypertrophy,8.40%(252)with carotid atherosclerosis,15.07%(452)with coronary heart disease,6.1%(184)with heart failure,13.60%(408)with ischemic stroke,6.80%(204)with hemorrhagic stroke,and 5.33%(160)with chronic kidney disease,respectively.During the hospitalization,29.60%(888)and 70.40%(2112)received monotherapy and combined antihypertensive medication.For the inpatients with monotherapy,20.72%(184)were treated with angiotensin-converting enzyme inhibitor(ACEI),17.12%(152)with angiotensin receptor blocker(ARB),19.82%(176)withβ-blocker,33.78%(300)with calcium channel blocker(CCB),and 8.56%(76)with diuretic;the drug use for antihypertension differed significantly by the grade of hypertension among the inpatients(χ^2=44.87,P<0.001).Among the inpatients with combined therapy,the proportions of medication regimen were 16.29%(344)for ACEI/ARB+CCB,9.28%(196)for ACEI/ARB+diuretics,16.67%(352)for CCB+β-blocker,19.70%(416)for ACEI/ARB+β-blocker+CCB,26.33%(556)for ACEI/ARB+CCB+diuretic,and11.74%(248)for ACEI/ARB+β-blocker+diuretic;there was a significant difference in medication regimen between the inpatients with gradeⅡand gradeⅢhypertension(χ^2=138.45,P<0.001).Conclusion Antihypertensive medication regimen differs by the grade of the disease among young hypertension inpatients and the course of the disease needs to be concerned in rational drug use in the young hypertension patients.