당뇨병이 동반된 고혈압 환자에 대한 항고혈압제 선택의 변화: 포항 · 경주 1차 의료 연구망을 중심으로
Change of Selection to Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang · Gyeongju Primary Care Research Network
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연구배경: 당뇨병이 동반된 고혈압 환자의 항고혈압제는 angiotensin converting enzyme inhibitor (ACEI) 또는 angiotensin Ⅱ type 1 receptor blocker (ARB)가 일차선택약제로 권고 되고 있 다. 하지만 2005년 포항 · 경주 지역 개원의 대상 연구에서는 처 방률이 30.8%에 지나지 않았다. 이에 3년이 지난 후 동일 지역 개원의 처방률 변화에 대한 연구를 시행하였다. 방법: 연구에 동의한 9명의 가정의학과 개원의들이 2008년 1 월부터 3개월간 방문 순서대로 20개씩 제출한 당뇨병이 동반 된 고혈압 환자의 처방전 152개를 분석하였다. 분석 후 연구에 참여한 개원의들에게 직접 방문하여 약물의 선택의 이유를 확인하였다. 결과: 항고혈압제 처방 행태는 총 16가지였다. ACEI 또는 ARB 처방 수는 101개(66.4%)였다. 이중 ACEI 단독요법이 19 예(12.5%), ACEI 병용요법이 7예(4.6%), ARB 단독요법이 31예 (20.4%), ARB 병용요법이 44예(28.9%)로 나타났다. ACEI 또는 ARB의 선택 이유는 권고 기준 이행 5명(55.6%), 강압효과 3명 (33.3%), 신약홍보 1명(11.1%) 순이었다. 결론: 당뇨병이 동반된 고혈압 환자에 대한 항고혈압제로서 ACEI 또는 ARB 선택이 30.8%에서 66.4%로 크게 증가하였다. 약제 선택 이유는 연구 참여에 따른 권고 기준 습득과 강압효 과가 뛰어난 새로운 약제의 개발로 인해 크게 증가된 것으로 생각된다.
Abstract
Background: Angiotensin converting enzyme inhibitors (ACEIs) or Angiotensin Ⅱ type 1 receptor blockers (ARBs) are compelling indication drugs for hypertensive patients with diabetes mellitus. But prescription rate in 2005 year study of Pohang · Gyeongju area was only 30.8%. Therefore, a study on the change of prescription rate in the same area after 3 years was done. Methods: During three months from January 2008, 152 hypertensive patients with diabetes mellitus on their prescribed antihypertensive medications by 9 family physicians in visiting order were analyzed. After the analysis, the infl uencing factors for such prescriptions were ascertained by directly visiting each physicians who prescribed them. Results: A regimen of 16 antihypertensive agents were prescribed by these family physicians. Prescription count of ACEIs or ARBs was 101 cases (66.4%). ACEIs single therapy was 19 cases (12.5%), ACEIs combination therapy was 7 cases (4.6%), ARBs single therapy was 31 cases (20.4%) and ARBs combination therapy was 44 cases (28.9%). The ACEIs or ARBs which were selected by physicians that followed "compelling indication" was 5 (55.6%), "excellent reduce pressure effect" was 3 (33.3%) and "public relations of new medicine" was 1 (11.1%). Conclusion: In prescribing antihypertensive agents for patients with diabetes mellitus, selection of ACEIs or ARBs was increased from 30.8% to 66.4%. Education of recommended standard by participating in such study and developing of excellent new medicines may increase such change.
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