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2011, vol. 17, br. 3-4, str. 97-111
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Lečenje hipertenzije u primarnoj zdravstvenoj zaštiti - mesto fiksnih kombinacija antihipertenziva
The treatment of hypertension in primary health care: The role of fixed-dose combinations of antihypertensives in hypertension therapy
Sažetak
Uvod: Arterijska hipertenzija je bolest koju karakterišu povišene vrednosti sistolnog pritiska sTA ≥ 140 mm Hg i dijastolnog krvnog pritiska dTA ≥ 90 mm Hg za zdrave osobe starije od 18 godina koje ne koriste antihipertenzivnu terapiju. Hipertenzija je jedan od najvažnijih faktora kardiovaskularnog rizika, posebno za koronarnu bolest. Cilj rada: Cilj ovog istraživanja je pokazati da je izbor vrste terapije i primena izabrane terapije u skladu sa Evropskim preporukama o fleksibilnosti izbora leka na početku terapije i poređenjem efikasnosti primenjene antihipertenzivne terapije pokazati mesto fiksnih kombinacija u terapiji hipertenzije. Metod: Metodom upitnika dizajniranog za potrebe retrospektivno- prospektivne studije, istraživanje je obavljeno u periodu od novembra 2007. do februara 2009. godine na teritoriji Doma zdravlja 'Zvezdara' u Beogradu. Rezultati: U istraživanju je učestvovalo 244 ispitanika, 101 (41,4%) muškarac i 143 (58,6%) žene, oboleli od hipertenzije, prosečnog starosnog doba 56,55±9,39 godina. Na prvom pregledu 42,62% ispitanika s vrednošću sTA 152,45±10,024 mm Hg i dTA 96,25±4,12 mm Hg koristilo je kombinovanu terapiju s fiksnim kombinacijama. Terapiju fiksnih kombinacija primenilo je 29,50% ispitanika, kod kojih je vrednost sTA 150,97±7,103 mm Hg i dTA 95,60±4,048 mm Hg. Kombinovanu terapiju koristilo je 23,77% ispitanika s vrednošću sTA 158,45±11,668 mm Hg i dTA 98,45±5,397 mm Hg (p<0,01); 43,03% ispitanika normalizovalo je krvni pritisak na četvrtom pregledu, 36,06% na trećem i 13,93% ispitanika na drugom kontrolnom pregledu, od kojih je 7,37% koristilo fiksne kombinacije (p<0,01). Od 43,03% obolelih koji su normalizovali krvni pritisak, 18,03% je koristilo kombinovanu terapiju s fiksnim kombinacijama, 14,75% kombinovanu terapiju i 9,42% ispitanika terapiju s fiksnim kombinacijama (r<0,05); 79,50% ispitanika je normalizovalo pritisak na vrednosti visoko normalnog pritiska 135/85 mm Hg, a 13,52% pacijenata na vrednosti normalnog pritiska 125/80 mm Hg (p<0,01). Zaključak: Fiksne kombinacije u terapiji hipertenzije pokazuju visoku efikasnost u brzini normalizacije krvnog pritiska dajući najveći broj ispitanika s normalizovanim krvnim pritiskom na drugom pregledu nakon prva četiri meseca terapije, i efikasnost u normalizovanju krvnog pritiska na kraju studije.
Abstract
Introduction: Arterial hypertension is a disease characterized by elevation of both systolic (SP≥ 140 mmHg) and diastolic blood pressure (DP≥ 90 mmHg) in otherwise healthy persons older than 18 years, who do not use antihypertensive therapy. Hypertension is one of the most important risk factors for cardiovascular diseases, especially coronary disease. Objective: The aim of this research was to demonstrate that the selection of the type of therapy and the application of the selected therapy is in accordance with the European recommendations on flexibility of drug selection at the beginning of the therapy, and to indicate the role of fixed-dose combinations in antihypertensive therapy by comparing efficacy of the applied antihypertensive therapy. Methods: The research was conducted from November 2007 to February 2009 on the territory of the 'Zvezdara' health center in Belgrade. The research was conducted by using the questionnaire designed for a retrospective-prospective study. Results: The research included 244 patients, 101 male (41.4%) and 143 female (58.6%), suffering from hypertension. The average age of the patients was 56,55 ± 9,39 years. At the first examination 42.62% of the patients used the combined therapy with fixed-dose combinations. Their SP value was 152,45 mmHg ± 10,024 and DP value 96,25 mmHg ± 4,12. Fixed-dose combinations therapy used 29.50% of the patients, SP value was 150,97 mmHg ± 7,103 and DP value 95,60 mmHg ± 4,048. Combined therapy used 23.77% of the patients, SP value was 158,45 mmHg ± 11,668 and DP value 98,45 mmHg ± 5,397 (p< 0,01). At the fourth examination blood pressure was normalized in 43.03% of the patients, at the third examination 36.06% of the patients had a normalized blood pressure and 13.93% of the patients had a normalized blood pressure at the second examination. 7.37% of these patients used fixed-dose combinations (p<0,01). Out of 43.03% of the patients whose blood pressure was normalized, 18.03% used the combined therapy with fixed-dose combinations, 14.75% used the combined therapy and 9.42% used the fixed-dose combinations therapy (r < 0,05). In patients with normalized blood pressure 79.50% had high-normal blood pressure (135/85 mmHg) and 13.52% had optimal blood pressure (125/80 mmHg) Conclusion: The use of fixed-dose combinations in the hypertension therapy demonstrated high efficiency in blood pressure normalization. In majority of patients blood pressure was normalized at the second examination, after the first four months of using the therapy.
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