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Suitability of antiplatelet therapy in hypertensive patients
M J Martínez-Orozco1, Z Perseguer-Torregrosa2, V F Gil-Guillén3
11] Miguel Martínez Community Pharmacy, Benimantell, Spain [2] Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.
Insights
In hypertensive patients, antiplatelet therapy (AT) prescription showed significant inertia in secondary prevention and non-guideline-recommended use in primary prevention. Factors like female sex and no dyslipidemia were linked to inertia, while male sex, smoking, dyslipidemia, and diabetes were linked to NGRP.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Antiplatelet therapy (AT) is crucial for hypertensive patients with elevated cardiovascular risk.
- Limited literature exists on the appropriate or inappropriate prescription patterns of AT in this population.
- Understanding therapeutic inertia and non-guideline-recommended prescriptions (NGRP) is vital for optimizing patient care.
Purpose of the Study:
- To quantify therapeutic inertia and NGRP of AT (aspirin, clopidogrel, or both) in hypertensive patients.
- To identify factors associated with inertia and NGRP in both primary and secondary prevention settings.
- To assess the adherence to clinical guidelines for AT prescription in a real-world healthcare setting.
Main Methods:
- Prospective descriptive study involving 712 primary healthcare hypertensive patients in Spain (2007-2009).
- Inertia defined as the absence of indicated AT; NGRP defined as AT prescription without guideline recommendation.
- Multivariate models used to calculate adjusted odds ratios (ORs) for associated factors, including cardiovascular variables.
Main Results:
- In secondary prevention (108 patients), therapeutic inertia was observed in 49.1% (53 patients). Associated factors included female sex, absence of dyslipidemia, no coronary heart disease, and high diastolic blood pressure.
- In primary prevention (595 patients), NGRP was present in 11.6% (69 patients). Associated factors included male sex, smoking, dyslipidemia, and diabetes.
- Specific patient characteristics were clearly associated with both therapeutic inertia and NGRP, indicating areas for targeted intervention.
Conclusions:
- Significant rates of both therapeutic inertia and non-guideline-recommended antiplatelet therapy prescription exist in hypertensive patients.
- Patient demographics and clinical factors, such as sex, comorbidities (dyslipidemia, coronary heart disease, diabetes), and blood pressure, influence AT prescription patterns.
- Further research is needed to fully understand and address the complexities of AT prescribing to improve cardiovascular risk management in hypertensive individuals.
Abstract:
Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.
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