Spremembe in možne poenostavitve farmakoterapije povišanega krvnega tlaka pri internističnih bolnikih ob odpustu s Klinike Golnik

Japelj, Nuša (author), Knez, Lea (mentor)

Hospitalizacija je povezana s spreminjanjem farmakoterapije bolnikov. Spremembe so pogoste tudi pri antihipertenzivnih zdravilih, čeprav vzrok hospitalizacije največkrat ni neurejen krvni tlak. Namen magistrske naloge je bil preučiti spremembe in možne poenostavitve farmakoterapije povišanega krvnega tlaka pri internističnih bolnikih ob in po odpustu s Klinike Golnik. V opazovalno raziskavo smo vključili odrasle bolnike, ki so imeli predpisana antihipertenzivna zdravila pred sprejemom ali ob odpustu iz bolnišnice. Podatke o zgodovini zdravljenja z zdravili pred sprejemom smo pridobili preko pogovora z bolniki, podatke o predpisanih zdravilih ob odpustu iz bolnišničnega e-informacijskega sistema, podatke o zdravilih 30 dni po odpustu pa preko telefonskega pogovora z bolniki. Antihipertenzivna zdravila je uporabljalo 76 % bolnikov (299/394), pri katerih je bila mediana predpisanih učinkovin 2. Najpogosteje so imeli predpisane zaviralce angiotenzinske konvertaze, antagoniste angiotenzinskih receptorjev AT1, antagoniste adrenergičnih receptorjev beta, zaviralce kalcijevih kanalčkov ter tiazide ali tiazidom podobne diuretike. Spremenjeno farmakoterapijo povišanega krvnega tlaka ob odpustu je imelo 62 % bolnikov (184/299), s povprečjem 1,5 sprememb na bolnika. Predlagane spremembe bi le pri 36 % bolnikov (107/299) pripeljale do spremembe krvnega tlaka za vsaj 5 mmHg oz. pri 17 % bolnikov (50/299) za vsaj 10 mmHg. Spremenjeno farmakoterapijo povišanega krvnega tlaka 30 dni po odpustu smo zabeležili pri 37 % bolnikov (88/239) in večina, kar 9 od 10 bolnikov, je imela spremenjeno farmakoterapijo že ob odpustu iz bolnišnice. Spremembe 30 dni po odpustu so bile v 53 % primerov (67/126) nasprotujoče spremembam ob odpustu. O omotici in vrtoglavici je v 30 dneh po odpustu poročalo 28 % bolnikov (43/153), padce pa 4,5 % bolnikov (6/133). Vsaj 1 od 10 bolnikov bi ob odpustu lahko poenostavili zdravljenje povišanega krvnega tlaka z uvedbo kombiniranega zdravila. Večina hospitaliziranih bolnikov ima antihipertenzivna zdravila in več kot polovica teh bolnikov ima spremembe teh zdravil ob odpustu iz bolnišnice, ob katerih pa pri večini bolnikov ne pričakujemo sprememb v vrednosti krvnega tlaka. Zanimivo je, da so spremembe farmakoterapije 30 dni po odpustu v polovici primerov nasprotne spremembam farmakoterapije predlaganim ob odpustu, morda tudi zaradi slabe komunikacije z bolnikom ob odpustu ali z bolnikom ali osebnim zdravnikom po odpustu iz bolnišnice.

• Language: Slovenian
• Keywords: Povišan krvni tlak, farmakoterapija, smernice, usklajevanje zdravljenja z zdravili, neželeni dogodki zdravljenja z zdravili.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2021
• PID: 20.500.12556/RUL-129906
• Publication date in RUL: 09.09.2021

Secondary language

• Language: English
• Title: Changes and possible simplifications in antihypertensive pharmacotherapy of internistic medical patients at discharge from the Golnik Clinic

Abstract

Hospitalization is associated with a change in pharmacotherapy, which often includes antihypertensive medications, although blood pressure is often not the cause of hospitalization. The aim of this study is to investigate the changes and possible simplifications of antihypertensive pharmacotherapy in medical patients at and after discharge from the University Clinic Golnik. The observational study included adult patients who had been prescribed antihypertensive medications before hospital admission or at discharge. Comprehensive medication history was obtained by interviewing patients, discharge therapy was obtained from the hospital medical records, and information on medication therapy 30 days after discharge was obtained by interviewing patients by telephone. Antihypertensive drugs were taken by 76% of admitted patients (299/394), who used a median of two medications. In most cases, the antihypertensives prescribed were angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers and thiazides or thiazide-like diuretics. A total of 62% of patients (184/299) had their antihypertensives changed at discharge, with an average of 1,5 changes per patient. The proposed changes resulted in a change in blood pressure of at least 5 mmHg and 10 mmHg in only 36% (107/299) and 17% (50/299) of patients, respectively. After discharge, antihypertensive pharmacotherapy was changed in 37% of patients (88/239), and the vast majority of patients (9 of 10) already had changes at discharge, with proposed changes often opposite to those at discharge (53%, 67/126). Dizziness and vertigo were reported by 28% of patients (43/153) in the first month after discharge whereas 4,5% of patients (6/133) reported falls. Antihypertensive pharmacotherapy could be simplified for at least 1 in 10 patients by introducing a fixed-dose combination at discharge. Most hospitalized patients were taking antihypertensive medications and a change in antihypertensive treatment was suggested in more than half of these patients at hospital discharge but this was not expected to result in a change in blood pressure in most patients. Interestingly, of half of the changes in antihypertensive medication suggested at discharge, an opposite change was made within 30 days of discharge, possibly due to inadequate communication with the patient and primary medical staff.

• Keywords: Hypertension, pharmacotherapy, guidelines, medication reconciliation, adverse drug events.