Hypertension control in the community: the analysis of anti-hypertensive drugs use at the initial stage of management

Abstract

Objective To evaluate the effectiveness of short term training on knowledge related to anti-hypertensive medical treatment among the selected Chinese community physicians. Methods A protocol of standardized community-based hypertension management was developed based on the current Chinese guidelines for prevention, treatment of hypertension. The grass-roots doctors from community health service centers across China were trained using this protocol and required to manage hypertensive patients according to the protocol. After the training, the first antihypertensive prescriptions to patients managed by the doctors were recorded. Results In a total of 30,553 patients with complete information, calcium channel blockers (CCB) (44.8%) was the most frequently prescribed drug, followed by fixed-dose combination (FDC) (44.3%) and angiotensin-converting enzyme inhibitor (ACEI) (12.4%). Out of them, 76.2% patients were on monotherapy or using FDC and Traditional Chinese Medicine (TCM); FDC was the most frequently prescribed drug as a single agent, followed by CCB (34.8%) and ACEI (12.4%).Except for the FDC and TCM, 5,290( 17.3%) were on combination therapy with two or more than two first line antihypertensive drugs, 84.4% prescriptions of combinations of two drugs and 91.6% of combinations of three drugs were in accordance with the Guidelines respectively, with the combination of CCB and ACEI, and the combination of diuretics, CCB and beta receptor blocker were the most frequently prescribed drug class. The proportion of combination therapy increased along with the risk stratification rising. Conclusions After being trained, the combinations prescribed by grass-roots doctors were mostly in accordance to the Guidelines, and the patients were give more intensive therapy with the higher the risk stratification. However, further trainings are needed to get more improvement.