목적: 진료현장에서 항고혈압제처방의 형태를 전향적으로 관찰하여 환자의 약물의 처방형태의 변화양상에 따른 혈압조절률을 파악하고자 한다. 방법: 연구대상은 2001년부터 2009년까지 서울시 1개 보건소에서 고혈압으로 진료받은 환자 1,558명으로 이들은 보건소에 처음 내원하고 처음 약처방 시 140 mmHg 이상인 환자들이다. 이들의 처방 15회까지의 처방양상 및 혈압조절률을 분석하였다. 결과: 첫 처방 후 2번째 방문 시의 140 mmHg 이하가 된 혈압의 조절률은 31.3%이었다. 첫 처방 시의 약 효과를 첫 처방 시의 혈압과 2번째 방문 시의 혈압의 차이로 강압효과를 측정하면 ACEI는 -11.4 mmHg, ARB는 -14.5 mmHg, BB는 -13.3 mmHg, AB는 -10.6 mmHg, DCZ는 -8.8 mmHg, CCB는 -12.9 mmHg의 강압효과를 나타내어 ARB의 강압효과가 다소 높은 것으로 분석되었다. 첫 처방 시 많이 처방한 혈압약 순서로는 CCB가 831건(52.3%)로 가장 많았고, 그 다음으로는 BB가 246건(15.5%), DCZ가 228건(14.4%), ACEI가 125건(7.9%), ARB가 143건(9.0%) 순이었다. 처음 처방 후 두 번째 처방 시 다른 혈압약(monotherapy)으로 변경하는 행태를 살펴보면, 첫 처방 후 2번째 약변경은 CCB로 변경하였다. 처음 처방 후 두 번째 내원 시 다른 혈압약을 첨가하는 병합요법(combination therapy)의 처방행태를 살펴보면, 대체적으로 DCZ, CCB, BB 순으로 약물을 첨가하였다. 15회째 처방을 기준으로 조절률을 평가할 때 가장 조절률이 높은 처방형태는 단일 처방으로 CCB (72.9%), DCZ (71.6%) 계열의 약물로 나타났다. 병합요법 중에 가장 높은 조절률을 보인 형태는 BB+DCZ+CCB (69.2%)이었다. 결론: 혈압조절률은 방문 시마다 계속 증가하여 14회 방문시 이후로는 69.8%로 혈압조절률의 증가세가 정체(Plateau)되는 양상을 보였다. 15회째 고혈압약 처방양상 살펴보면 연구 대상자 1,588명 중에서 847명(53.3%)가 단일처방으로 혈압을 치료받고 있었고, 복합처방은 741명(46.7%)에 대해서 치료받고 있었다. 향후 혈압조절률의 정체를 설명할 수 있는 연구가 저항성 고혈압 등의 관점에서 행해져야 할 필요성이 제기된다.

Background/Aims: This study was performed to observe blood pressure (BP) control rate with changes in patterns of antihypertensive drugs in patients with hypertension. Methods: The subjects were first prescribed antihypertensive drugs from 2001 to 2009 at [Nowon] health center. The study population consisted of 1588 subjects, and they were observed with 15 additional prescriptions through prospective cohort methods. Patient initial systolic blood pressures (SBP) were >140 mmHg in all cases. Results: BP was controlled in 31.3% of subjects through the first prescribed antihypertensive drugs. Calcium channel blockers (CCB) were the most common first‐choice medications (52.3%), which lowered BP by 12.9 mmHg at the first prescription. The most common converted drugs in monotherapy were CCB, and CCB were converted to angiotensin II type 1 receptor blockers (ARB). Dichlozide (DCZ) was the most common medication added to CCB. The combination patterns involved addition of DCZ, CCB, and beta blockers (BB). The most common combination pattern was DCZ+CCB, and CCB (72.9%) showed the strongest BP control rate at the endpoint. Among the combination therapies, BB+DCZ+CCB (69.2%) showed the strongest BP control rate at the endpoint. Conclusions: The control rate was increased with additional visits but reached a plateau (69.8%) after the 14th visit. The percentages of monotherapy and combinations were 53.3% and 46.7%, respectively. To increase the overall control rate, further studies are needed to evaluate uncontrolled hypertension from the viewpoint of resistant hypertension. (Korean J Med 2011;80:193-202)

Background/Aims: This study was performed to observe blood pressure (BP) control rate with changes in patterns of antihypertensive drugs in patients with hypertension. Methods: The subjects were first prescribed antihypertensive drugs from 2001 to 2009 at [Nowon] health center. The study population consisted of 1588 subjects, and they were observed with 15 additional prescriptions through prospective cohort methods. Patient initial systolic blood pressures (SBP) were >140 mmHg in all cases. Results: BP was controlled in 31.3% of subjects through the first prescribed antihypertensive drugs. Calcium channel blockers (CCB) were the most common first‐choice medications (52.3%), which lowered BP by 12.9 mmHg at the first prescription. The most common converted drugs in monotherapy were CCB, and CCB were converted to angiotensin II type 1 receptor blockers (ARB). Dichlozide (DCZ) was the most common medication added to CCB. The combination patterns involved addition of DCZ, CCB, and beta blockers (BB). The most common combination pattern was DCZ+CCB, and CCB (72.9%) showed the strongest BP control rate at the endpoint. Among the combination therapies, BB+DCZ+CCB (69.2%) showed the strongest BP control rate at the endpoint. Conclusions: The control rate was increased with additional visits but reached a plateau (69.8%) after the 14th visit. The percentages of monotherapy and combinations were 53.3% and 46.7%, respectively. To increase the overall control rate, further studies are needed to evaluate uncontrolled hypertension from the viewpoint of resistant hypertension. (Korean J Med 2011;80:193-202)

Control rate; Monotherapy; Combination therapy