Hypertension Control in Community Health Centers Across China: Analysis of Antihypertensive Drug Treatment Patterns

• Published in: American journal of hypertension 2014-02, Vol.27 (2), p.252-259
• Main Authors: Wang, Zengwu, Wang, Xin, Chen, Zuo, Wang, Wen, Zhu, Haidi, Chen, Weiwei, Zhu, Manlu, Hu, Shengshou, Staessen, Jan A., Liu, Lisheng, Fodor, J. George
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Calcium Channel Blockers - therapeutic use; China; Community Health Centers; Diuretics - therapeutic use; Drug Combinations; Drug therapy; Drug Utilization; Female; Health facilities; Humans; Hypertension; Hypertension - drug therapy; Male; Medical research; Middle Aged; Substance abuse treatment
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpt186

BACKGROUND Blood pressure (BP) control in China is generally poor. It is assumed that an important cause of this unsatisfactory situation is the present standard of care provided by primary care physicians. METHODS One thousand community health centers (CHCs) were selected across China based on geographical location, previous cooperative experience, and acceptance of an invitation to implement a standardized protocol of community-based BP management. Baseline information for each hypertensive patient under the care of these CHCs was collected, and the present pattern of hypertensive drug treatment was analyzed. RESULTS Of all identified hypertensive patients (n = 249,830), 37% were treated with drugs. Characteristics linked with hypertension treatment included systolic BP, age, sex, region, smoking and alcohol consumption status, body mass index, comorbidities, and family history. The most frequently prescribed classes of antihypertensive drugs were diuretics (56.0%), followed by centrally active drugs (CADs) (38.3%), calcium channel blockers (CCBs) (36.8%), vasodilators (26.5%), and angiotensin-converting enzyme inhibitors (ACEIs) (23.3%). In regards to drug combination patterns, diuretics plus CADs was the most frequently used 2-drug combination (61.4%) and vasodilators plus CADs plus diuretics was the most frequently used 3-drug therapy (69.2%). Seventy-seven percent of patients on combination therapy were prescribed single pill combinations, 87.2% of which were composed of CADs and vasodilators and 12.8% of which were composed of ACEIs and diuretics. The control rates of patients on monotherapy and combination therapy were 27.7% and 24.1% (P < 0.05), respectively. CONCLUSIONS Our study identified major shortcomings in the present status of antihypertensive pharmacotherapy in routine medical practice in China. It is essential to implement a program of professional education regarding the appropriate use of antihypertensive drugs.