台灣之高血壓藥物治療型態-1998年處方箋分析

Pattern of Pharmacologic Treatment of Hypertension in Taiwan-Analysis of Antihypertensive Prescriptions in 1998

廖文評(Wen-Ping Liao) ； 葉明功(Ming-Kung Yeh) ； 柯景馨(Ching-Hsing Ke) ； 羅慶徽(Ching-Hui Loh) ； 周稚傑(Chih-Chieh Chou)

《台灣家庭醫學雜誌》 14卷3期 (2004/09) Pp. 121-132

https://doi.org/10.7023/TJFM.200409.0121

摘要

本研究主要藉由中央健康保險申報的資料庫，分析醫事服務機構就診之高血壓門診申報處方箋型態。本研究資料來自中央健康保險局之健保資料庫，研究對象為1998年1月1日至6月30日台灣二千一百萬人民，研究方法係採用檔案分析法，探討診斷為高血壓的所有案例與其處方，針對性別與年齡層等變項，藉著分析各種類型的降血壓藥物，進行描述性分析門診申報處方箋型態及相關性。探討國人高血壓治療情形，並比較不同年齡層與性別間的給藥模式之差異。研究結果，在資料收集期間共獲得5，107，346筆有效之高血壓門診處方箋，總計有8，711，031筆降血壓藥物資料。經統計結果各類降血壓藥物所佔比例如下：鈣離子通道阻斷劑(Calcium channel blockers,以下簡稱CCBs)佔57.56%;β-阻斷劑(Beta-blocker)佔43.6%;血管張力素轉化酶抑制劑(Angiotensin converting enzyme inhibitor,以下簡稱ACEI)佔31.74%;利尿劑佔20.91%；其它類佔16.68%。研究中發現，CCBs與利尿劑的使用，隨著患者年齡上升而增加：年齡層在40歲前的男性患者，CCBs使用比例為48.75%，75歲後上升至55.58%，利尿劑使用比例則由12.72%上升到23.65%；相對於女性患者，前者由42.21%上升到58.15%，後者由16.07%上升到26.50%。相反的，β-阻斷劑使用比例，卻隨著患者由56.38%下滑至32.86%。而ACEI的使用比例，亦隨著患者年齡增加而輕微下滑：男性患者36.26%下滑至31.69%，女性患者由32.04%下滑至30.38%。此外，男性患者較常被投予其它類、ACEI以及CCBs等藥物來治療高血壓，較少用到利尿劑和β-阻斷劑。高血壓患者的年齡層與性別差異，往往影響到降血壓藥物的選擇。適當的治療模式對整體預後相當重要，所以臨床醫護人員在面臨高血壓患者時，應該正確地選擇適當的用藥。

並列摘要

The prevention & treatment of hypertension is an important issue in public health. Treatment patterns of hypertension provide valuable information for clinicians. This study attempts to explore, by analyzing patterns of antihypertensive medications, multiple treatments of hypertension by pharmacology classification and the modalities among different age groups and genders. The unique reimbursement system of National Health Insurance (NHI) facilitates the processing of data collection for 21 million people in Taiwan utilizing this system. We extracted those claims which had both a diagnosis of hypertension as well as a prescription of anti-hypertensive medications during the period from Jan 1 to Jun 30, 1998. A cross-sectional descriptive analysis was performed and broken down by patients' gender and age groups. Multiple logistic regression was performed to test the prescriptive preference between genders. A total of 5,107,346 prescriptions containing 8,711,031 drug items were collected during the six-month study. Of all antihypertensive medications there were ACE inhibitor (31.74%), .9 –blocker (43.67%), calcium channel blockers (57.56%), diuretics (20.91%), and others (16.68%). Certain patterns in the prescription of calcium channel blockers and diuretic agents were noted as patients’ ages increased. For males, calcium channel blockers rose from 48.75% for those aged under 40 yrs to 55.58% for those older than 75 yrs, while diuretic agent increased from 12.72% to 23.65%. For aging females, the rate of increase was from 42.21% to 58.15% and from 16.07% to 26.50%, respectively. On the contrary, some prescription patterns decreased. For males, β-blocker prescriptive rate decreased significantly in older patients, dropping from 55.15% for those aged under 40 yrs to 32.44% for those older than 75 yrs and respectively, from 56.38% to 32.86% for females. The ACE inhibitors slightly decreased with an increase in the patients' age from 36.26% to 31.69% for males and from 32.04% to 30.38% for females, respectively. Males were more likely to be prescribed with others, ACE inhibitor, and calcium channel blockers, but less likely with diuretics and β-blockers. The patients' age and gender does influence pharmacological treatment of hypertension. The pattern of treatment is far more significant for prognosis and clinicians should be sensitive in choosing and titrating medications for hypertensive patients.

並列關鍵字

ambulatory care ； hypertensive disease ； hypertensive medicine ； prescription profile

參考文獻

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行政院衛生署1993-1996年國民營養健康狀況變遷調查結果