Via practica 3/2020
Gaps in quality and effectiveness of drug therapy of arterial hypertension: Use of central antihypertensive agents and alpha blockers in the treatment of arterial hypertension in the light of the 2018 ESC/ESH 2018 Guidelines for the management of arterial
The 2018 ESC/ESH Guidelines for the management of arterial hypertension introduced detailed drug treatment algorithm for hypertension. In this manuscript we compared clinical practice in Slovakia with published Guidelines. We analyzed the prescription of central antihypertensive drugs (methyldopa, moxonidine, rilmenidine) and alpha blockers (doxazosin, urapidil) in the period just before the publication of the guidelines. The drugs under review have limited support in evidence-based medicine and most of them lack long-term outcome data on morbidity and mortality. Their chronic use as part of 2- to 4-drug combinations in patients with hypertension without comorbidities is not in accordance with guideline-based recommendations. Nevertheless, we have identified 7.2 % of comorbidity free hypertensive patients treated with such combinations. Older patients were more frequently prescribed such suboptimal combinations so that they were used in 9.5 % of octogenarians. There are significant regional differences in prescription patterns: In the Trenčín and Prešov regions, the analyzed drugs are prescribed significantly more often than in the Banska Bystrica or Žilina regions. Neither number of treated hypertensive patients nor physician’s age affected the analysed prescription behaviour. In addition, suboptimal drug combinations using central antihypertensives or alpha blockers come at higher costs for both health insurance and patient co-payment. When compared to suboptimal combination of central antihypertensives or alpha blockers, drug costs per patient treated with guideline recommended 2- to 4-combination of antihypertensive agents was on average 55 % and 33 % cheaper for the insurance and the patient, respectively.
Keywords: arterial hypertension, drug therapy, practice guidelines
