COMPARISON OF HOSPITALIZED AND AMBULATORY HYPERTENSIVE PATIENTS’ PHARMACOTHERAPY IN THE PERSPECTIVE OF POLYPRAGMASY

Abstract

Objective: Cardiovascular diseases cause 1/3 of all deaths, thus they represent a leading global cause of mortality. In Romania, 40% of the adult population is hypertensive, and only three out of seven, among the patients that are being treated, are getting the appropriate pharmacotherapy. Our goal is the evaluation and comparison of the pharmacotherapy of adult hospitalized and ambulatory hypertensive population. Design and method: The cross-sectional, observational, prospective, pharmaco-epidemiological study targets the observation, analysis and comparison of pharmacotherapy of two groups of patients (hospitalized and ambulant patients), in the perspective of polypragmasy and self-medication, if it occured. Results: The average age of hospitalized patients was 70.65+/−4.95 (SD) years, and 68.39+/−10.49 (SD) years of the outpatients. A statistically significant difference has been found regarding the gender rate in the two groups of patients (p = 0.0474), whereas 59% of the hospitalized patients were women compared to only 45% of the outpatients. A statistically significant difference has been found between the two groups’ angiotensin convertase enzyme inhibitors (ACEI) use: 44.86% in case of inpatients and 70.52% in case of outpatients (p = 0.0006), and also regarding the usage of beta-receptor blockers (63.83% hospitalized vs. 44.5% ambulatory). The incidence of polypragmasy of inpatients was 85.12% and in 4.26% of the cases a combination of more than ten drugs occurred. Compared to the ambulatory patients, where the incidence rate of polypragmasy was 61.84% and 6.93% of them used more than ten different drugs daily, the difference is statistically significant (p = 0.0004). Conclusions: Female hypertensive patients are more likely to be hospitalized due to their complications. Beta-receptor blockers are more frequently used in hospitalized cases, and ACEI are more widespread in case of ambulatory patients. A possible explanation includes that the use of ACEI is safer and produce less side effects than beta-blockers, which are tested on hospitalized patients before the long-term introduction in their therapy. Polypragmasy is common in both groups of patients, but it seems to occur at higher rates in case of inpatients, due to the more intense monitoring possibilities.