PHARMACOEPIDEMIOLOGY OF USING OF ANTIHYPERTENSIVE DRUGS BY FAMILY PHYSICIANS

The purpose of the study: to study the features of the rational use of antihypertensive drugs (AHP) by family doctors on an outpatient basis and their analysis of compliance with current international recommendations.

Materials and methods: According to questionnaires specially developed for studying the pharmacoepidemiology of hypertension, interviews were conducted with family doctors working in health houses located in different regions of the country and the specifics of their appointment of hypertension to patients with hypertension were studied. The duration of medical experience of doctors is on average 22.6 ± 11.0 years.

Results: The main drugs in the prescription structure were ACE inhibitors (19.7%), beta-blockers (19.6%), calcium antagonists (19.1%, diuretics (18.9%) ARBs (12.8%). central action drugs – 8.5%, alpha-adrenergic blockers – 1.4%. ACE inhibitor administration structure: enalapril – 33.8%, lisinopril – 26.3%, captopril – 23.3%, perindopril – 10.1 %, ramipril – 4.7%, the rest - 1.3% Of the beta-blockers: atenolol – 35.7%, bisoprolol – 34.7%, propranolol -15.7%, metoprolol - 8.0%, nebivolol – 4.3% and carvedilol 1.7%. The structure of the appointment of calcium antagonists: amlodipine – 38,3%, nifedipine – 29.6%, verapamil 16.8%, nifedipine SR and verapamil SR 5.7% each, diltheazem 2.1%, the share of all the others no more than 1.8%. Diuretic structure: hydrochlorothiazide – 36.0 %, furosemide – 28.8%, spironolactone – 18.6%, indapamide – 13.5%, torasemide – 2.1%, acetazolamide – 0.9%. The main proportion of ARB was losartan (84.0%) valsartan (8.7%), candesartan (4.2%), all the rest – 3.1%. 38.1% of family doctors still prescribe a centrally acting drug – clofellin, an imidazoline receptor agonist moxonidine (physiotens) is prescribed by family doctors very rarely (1.8%).

73.2% of respondents seek to reduce blood pressure to 140/90 mm Hg. Art., and the rest are limited to lowering blood pressure to a «working» level. 33.7% of family doctors start hypertension with monotherapy with the selection of an effective dose of one drug. 40.6% of doctors prefer free combination of AHP, 54.7% consider fixed combinations to be convenient, the rest are low-dose combinations.

Conclusion: Our study confirms the need for further improvement of the rational use of AHP by family doctors

1. Klinicheskie rekomendatsii. Arterial’naya gipertonia u wzroslyx. 2020. 136 p. (in Russ.). Accessed April 15,2020 https://scardio.ru/content/Guidelines/Clinic_rek_AG_2020.pdf.

2. Chazova I.E., Zhernakova Yu.V. on behalf on the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic hypertension. 2019; 16 (1): 6- 31 (in Russ.) DOI: 10.26442/2075082X.2019.1.190179

3. Whelton P.K., Carey R.M., Aronov W.S. at al. 2017 ACC/AHA/AAPA/ ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; ¬Vol. 71 (¬6). P.1269-1324. DOI: 10.1161/HYP.0000000000000066.

4. Williams B., Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 2018; Vol. 39(33). P. 3021-3104. DOI:10.1093/eurheartj/ehy339.

5. Russian Society of Cardiology position paper on 2018 Guidelines of the European Society of Cardiology/ European Society of Arterial Hypertension for the management of arterial hypertension. Russian Journal of Cardiology. 2018; 23 (12): 131-142 (in Russ) http://dx.doi.org/10.15829/1560-4071-2018-12-131-142.

6. Leonova M.V., Shteinberg L.L., Belousov Yu.B. et al. Pharmacoepidemiolog of arterial hypertension in Russia: the analysis of physician’s acceptance (according to results of PIFAGOR IV). Systemic hypertension. 2015; 12 (1): 19-25 (in Russ.).