engleski

Pharmacotherapy of hypertension and blood pressure control in Croatia

Arterial hypertension (AH) is a significant health care problem in today&#8217; s world. Improving the quality of hypertension care is a general priority that will result in a diminished number of patients with congestive heart failure, coronary artery disease, peripheral vascular disease, stroke, and renal insufficiency. AH prevalence in Croatia is 37.5%. Cardiovascular (CV) and cerebrovascular diseases were the cause of over 50% of deaths in Croatia in 2004. Adequate managing of AH, which includes antihypertensive drugs, leads to reduction of CV and cerebrovascular morbidity and mortality. According to the drug utilization data during the five-year period (2001-2005) total cardiovascular drugs utilization increased 64.65%. Group of drugs acting on the renin angiotensin aldosterone system had a steady but the largest share (about 32%). The most frequently used antihypertensives in Croatia were amlodipine, lisinopril and lisinopril+hydrochlorothiazide. Financial consumption data showed the highest increase of angiotensin II receptor blockers at the rate of 3.6 times comparing 2004 vs. 2002. The increase was also noticed in the same period for the combinations of ACE-inhibitors and diuretics (70.57%) and calcium channel blockers (62.86%). There is a slight decrease in the financial consumption of ACE-inhibitors (5.44%) and of old calcium channel blockers (17.73%). A cross-sectional study performed during December 2003 and January 2004 analyses hypertension control (BP<140/90 mmHg). This study which included 141 primary care physicians and 814 hypertensive patients from different parts of Croatia, showed that a controlled BP in this hypertensive population treated with antihypertensive drugs was in 23% of patients. The analysis of BP control according to risk factors showed that significantly related with higher levels of systolic or diastolic BP were the age (poorer SBP control in patients older than 60 years), left ventricular hypertrophy, changes of the eye retina, smoking and diabetes mellitus. Further, patients from towns closer to the hospital, from urban centers, with higher education and employed had significantly lower average BP. In conclusion, the usage of cardiovascular drugs including antihypertensives in Croatia increased considerably during the last six-year period especially comparing the period after 2003 to previous years. This can be explained by a legal change in Croatia (the new Health Insurance Act) which introduced supplementary health insurance. On the other side the outcome measured as hypertension control in Croatia is not satisfactory and there is a need to improve the quality of hypertension care. In the patients treatment the relationship between demographic and cardiovascular risk factors with poor BP control should be taken into account.

arterial hypertension; therapy

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