The Korean Journal of Medicine

  • 제80권2호
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  • Pages.193-202
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

항고혈압제 단일처방 선택 후 혈압조절률과 처방변화양상

Blood Pressure Control Rate and Changes in Medication Patterns after Antihypertensive Monotherapy Choice

  • Published : 2011.02.01
⟨ 이전 논문 다음 논문 ⟩

Abstract

목적: 진료현장에서 항고혈압제처방의 형태를 전향적으로 관찰하여 환자의 약물의 처방형태의 변화양상에 따른 혈압조절률을 파악하고자 한다. 방법: 연구대상은 2001년부터 2009년까지 서울시 1개 보건소에서 고혈압으로 진료받은 환자 1,558명으로 이들은 보건소에 처음 내원하고 처음 약처방 시 140 mmHg 이상인 환자들이다. 이들의 처방 15회까지의 처방양상 및 혈압조절률을 분석하였다. 결과: 첫 처방 후 2번째 방문 시의 140 mmHg 이하가 된 혈압의 조절률은 31.3%이었다. 첫 처방 시의 약 효과를 첫 처방 시의 혈압과 2번째 방문 시의 혈압의 차이로 강압효과를 측정하면 ACEI는 -11.4 mmHg, ARB는 -14.5 mmHg, BB는 -13.3 mmHg, AB는 -10.6 mmHg, DCZ는 -8.8 mmHg, CCB는 -12.9 mmHg의 강압효과를 나타내어 ARB의 강압효과가 다소 높은 것으로 분석되었다. 첫 처방 시 많이 처방한 혈압약 순서로는 CCB가 831건(52.3%)로 가장 많았고, 그 다음으로는 BB가 246건(15.5%), DCZ가 228건(14.4%), ACEI가 125건 (7.9%), ARB가 143건(9.0%) 순이었다. 처음 처방 후 두 번째 처방 시 다른 혈압약(monotherapy)으로 변경하는 행태를 살펴보면, 첫 처방 후 2번째 약변경은 CCB로 변경하였다. 처음 처방 후 두 번째 내원 시 다른 혈압약을 첨가하는 병합요법 (combination therapy)의 처방행태를 살펴보면, 대체적으로 DCZ, CCB, BB 순으로 약물을 첨가하였다. 15회째 처방을 기준으로 조절률을 평가할 때 가장 조절률이 높은 처방형태는 단일 처방으로 CCB (72.9%), DCZ (71.6%) 계열의 약물로 나타났다. 병합요법 중에 가장 높은 조절률을 보인 형태는 BB+DCZ+CCB (69.2%)이었다. 결론: 혈압조절률은 방문 시마다 계속 증가하여 14회 방문 시 이후로는 69.8%로 혈압조절률의 증가세가 정체(Plateau) 되는 양상을 보였다. 15회째 고혈압약 처방양상 살펴보면 연구 대상자 1,588명 중에서 847명(53.3%)가 단일처방으로 혈압을 치료받고 있었고, 복합처방은 741명(46.7%)에 대해서 치료받고 있었다. 향후 혈압조절률의 정체를 설명할 수 있는 연구가 저항성 고혈압 등의 관점에서 행해져야 할 필요성이 제기된다.

Background/Aims: This study was performed to observe blood pressure (BP) control rate with changes in patterns of antihypertensive drugs in patients with hypertension. Methods: The subjects were first prescribed antihypertensive drugs from 2001 to 2009 at [Nowon] health center. The study population consisted of 1588 subjects, and they were observed with 15 additional prescriptions through prospective cohort methods. Patient initial systolic blood pressures (SBP) were >140 mmHg in all cases. Results: BP was controlled in 31.3% of subjects through the first prescribed antihypertensive drugs. Calcium channel blockers (CCB) were the most common first-ichoice medications (52.3%), which lowered BP by 12.9 mmHg at the first prescription. The most common converted drugs in monotherapy were CCB, and CCB were converted to angiotensin II type 1 receptor blockers (ARB). Dichlozide (DCZ) was the most common medication added to CCB. The combination patterns involved addition of DCZ, CCB, and beta blockers (BB). The most common combination pattern was DCZ+CCB, and CCB (72.9%) showed the strongest BP control rate at the endpoint. Among the combination therapies, BB+DCZ+CCB (69.2%) showed the strongest BP control rate at the endpoint. Conclusions: The control rate was increased with additional visits but reached a plateau (69.8%) after the 14th visit. The percentages of monotherapy and combinations were 53.3% and 46.7%, respectively. To increase the overall control rate, further studies are needed to evaluate uncontrolled hypertension from the viewpoint of resistant hypertension.

Keywords

References

  1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347-1360. https://doi.org/10.1016/S0140-6736(02)11403-6
  2. Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000 summary. Adv Data 2002;328:1-32.
  3. World Health Organization. Preventing chronic disease: a vital investment. Geneva, World Health Organization, 2005.
  4. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419. https://doi.org/10.1136/bmj.326.7404.1419
  5. Jee SH, Suh I, Kim IS, Appel LJ. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea medical insurance corporation study. JAMA 1999;282:219-2155. https://doi.org/10.1001/jama.282.3.219
  6. Borzecki AM, Oliveria SA, Berlowitz DR. Barriers to hypertension control. Am Heart J 2005;149:785-794. https://doi.org/10.1016/j.ahj.2005.01.047
  7. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998;1:2-4.
  8. Steinman MA, Fischer MA, Shlipak MG, et al. Clinician awareness of adherence to hypertension guidelines. Am J Med 2004;117:747-754. https://doi.org/10.1016/j.amjmed.2004.03.035
  9. Kim SY, Cho IS, Lee JH, et al. Physician factors associated with the blood pressure control among hypertensive Patients. J Prev Med Public Health 2007;40:487-494. https://doi.org/10.3961/jpmph.2007.40.6.487
  10. Kim KI, Kim Y, Kim HJ, et al. Current status and characteristics of hypertension treatment by primary physicians in Korea: data from Korean epidemiology study on hypertension (KEY study). Am J Hypertens 2008;21:884-889. https://doi.org/10.1038/ajh.2008.191
  11. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes : UKPDS 38. BMJ 1998;317:703-713. https://doi.org/10.1136/bmj.317.7160.703
  12. Jeffrey S. New JNC 7 hypertension guidelines released 2003. Available from: http://www.theheart.org/article/.
  13. Lee TY, Reconsideration of hypertension awareness, treatment, and control. Korean Hypertension J 2009;15:1-6.
  14. Taler SJ, Textor SC, Augustine JE. Resistant hypertension: comparing hemodynamic management to specialist care. Hypertension 2002;39:982-988. https://doi.org/10.1161/01.HYP.0000016176.16042.2F
  15. Hirsch S. A different approach to resistant hypertension. Clev Clin J Med 2007;74:449-456. https://doi.org/10.3949/ccjm.74.6.449
  16. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998;351:1755-1762. https://doi.org/10.1016/S0140-6736(98)04311-6
  17. Winker MA, Murphy MB. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final result of the systolic hypertension in elderly program (SHEP). JAMA 1991;265:3255-3264. https://doi.org/10.1001/jama.1991.03460240051027
  18. Park GS, Ra HJ, Joe HG, et al. Pattern of hypertensive management and usefulness of treatment guideline in primary care. J Korean Acad Fam Med 2006;27:789-797.
  19. Ostchega Y, Yoon SS, Hughes J, Louis T. Hypertension awareness, treatment, and control - continued disparities in adults: United States, 2005-2006. NCHS Data Brief 2008:1-8.
  20. 질병관리본부. 2008년 국민건강통계-국민건강영양조사 제4기 2차년도 조사결과 보고서. 2009.
  21. Mancia G, De Backer G, Dominiczak A, et al. 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the european society of hypertension (ESH) and the European society of cardiology (ESC). J Hypertens 2007;25:1105-1187. https://doi.org/10.1097/HJH.0b013e3281fc975a