Investigation of oral antihypertensive drugs used on patients with chronic renal disease combined with hypertension

Abstract

Objective To understand the rationality and safety of oral antihypertensive drugs on chronic renal disease (CKD) combined with hypertension hospitalized patients. Methods It was a multi-center and retrospective investigation. The electronic medical records of CKD with hypertension patients who were hospitalized in 6 comprehensive hospitals in Beijing and used oral antihypertensive drugs on October 1st, 2013 to March 31st, 2015 were collected. The pharmacists who participated in the project from the 6 research centers filled out the investigation form. According to the drug instruction, the rationality of antihypertensive medication was evaluated by daily dose, frequency of drug delivery, the dosage for renal insufficiency, contraindications and adverse interactions. Results There were 2 833 valid cases in this study, 1 730 males and 1 103 females. The ratio of male to female was 1∶ 0.64. The range of age was 18~101 years. The average age was (61±18) years. There were 1 630 (57.54%) cases whose age was ≥60; 314 (11.1%) cases were CKD level 1, 526 (18.6%) cases were CKD level 2, 1 117 (39.4%) cases were CKD level 3, 423 (14.9%) cases were CKD level 4, 453 (16.0%) cases were CKD level 5. 144 (5.1%) cases were hypertension level 1, 592 (20.9%) cases were hypertension level 2, 1 398 cases (49.3%) were hypertension level 3, and 699 (24.7%) cases were not graded. The oral hypotensive drugs applied during the hospitalization of 2 833 patients included calcium channel blockers (CCB), beta blockers, diuretics, angiotensin Ⅱ receptor blocker (ARB), angiotensin converting enzyme inhibitors (ACEI), alpha/beta blockers and alpha blockers. 1 022(36.1%) cases used 1 kind of antihypertensive drugs, 1 032(36.4%) cases used 2 kinds of antihypertensive drugs, 591(20.9%) cases used 3 kinds of antihyper-tensive drugs, 157(5.5%) cases used 4 kinds of antihypertensive drugs and 31(1.1%) cases used 5 kinds of antihypertensive drugs. A total of 6038 cases of antihypertensive drugs were administered. The top priority was CCB(35.11%, 2 120), the second was beta blockers(17.26%, 1 042) and the third was diuretics(16.23%, 980). The choice of a single drug for antihypertensive drugs was reasonable. The 2, 3, 4, 5 combined drug users who were not recommended by the guidelines were 4.8% (50/1 032), 21.2% (125/591), 28.0% (44/157) and 64.5% (20/31) respectively. The situation of blood pressure control was evaluated with blood pressure target values achieved rate. With blood pressure below 130/80 mmHg as the standard, the admission and discharge blood pressure target achieved rate was 31.2% (884/2 833) and 29.5% (799/2 705) respectively. With blood pressure below 140/90 mmHg as the standard, the admission and discharge blood pressure target achievement rate was 53.6% (1 519/2 833) and 64.4% (1 743/2 705) respectively. Among the 2 833 cases, 903 (31.9%) cases had 1 204 times of unreasonable use of the drug. The top three were excessive daily frequency of medication (1 029, 85.5%), total daily dosage (114, 9.5%), and use of drugs that were contraindicated (51, 4.2%). Two cases had adverse drug reactions related to antihypertensive drugs. Conclusion The use of antihypertensive drugs in patients with CKD in the six hospitals involved in the investigation was reasonable, but there was still some problems in the combination of drugs. Some doctors are not familiar with the drug instructions, and there are some problems such as increasing the frequency of drug use, overdose medication, and use of drugs that are contraindicated. Clinical pharmacists should be more involved in clinical work in these areas. Key words: Kidney disease; Hypertension; Antihypertensive agents; Safety