A mixed study on the use of diuretics and influencing factors in hypertensive patients in communities of Huai'an City,Jiangsu Province
Objective To analyze the use of diuretics and its influencing factors in hypertensive patients in communi-ties of Huai'an City,Jiangsu Province,China.Methods Using a cross-sectional study method,4 094 hypertensive patients in Huai'an City were enrolled from June to December 2022.The usage of diuretics and clinical data of pa-tients were analyzed.General practitioners(GPs)from communities and general hospitals were selected as inter-viewees during the same period.The contents of the interview mainly included the principles of antihypertensive drug prescription in the outpatient department,the principles of diuretic prescription,and the evaluation and suggestions of diuretics in the treatment of hypertensive patients.The results of the interview were analyzed by the topic frame-work analysis method.Results Among 4 094 patients,415 cases(10.14％)were using diuretics.The diuretics used by hypertensive patients were all long-acting preparations,with 162 patients(39.04％)using single tablets,which was lower than 253 patients(60.96％)using single-pill combination.The top three drugs used in terms of proportion were irbesartan hydrochlorothiazide(35.18％),indapamide(31.81％)and compound amiloride hydro-chloride(8.67％).The educational level,proportion of contracted family doctors services and complication,the lev-el of high density lipoprotein cholesterol(HDL-C)of patients who used diuretics were lower than those who did not use diuretics,and the course of hypertension,the proportion of living alone and grade 2 hypertension,the level of rest heart rate,fasting blood glucose,diastolic blood pressure,triglcyerid,low density lipoprotein cholesterol(LDL-C),serum creatinine were higher than those who did not use diuretics(all P＜0.05).The blood pressure control rate in patients using diuretic(37.83％)was higher than that in those not using diuretics(30.14％).Furthermore,the re-sults of multivariate logistic regression analysis indicated that low educational level(OR=1.292,95％CI 1.042-1.602),contracted family doctors services(OR=0.656,95％CI 0.518-0.830),living alone(OR=1.367,95％CI 1.067-1.752),complication(OR=0.786,95％CI 0.621-0.994),higher level of diastolic blood pressure(OR=1.017,95％CI 1.002-1.032),higher level of triglyceride(OR=1.114,95％CI 1.045-1.187)and higher level of LDL-C(OR=1.165,95％CI 1.046-1.298)were factors influencing the use of diuretics(all P＜0.05).Twenty GPs were interviewed,and three themes were extracted:① Most GPs believed that diuretics had good therapeutic effects.② For hypertensive patients,diuretics were generally not preferred or used alone.③ The wide variety of available antihypertensive drugs,significant side effects of diuretics,and no obvious price advantage,might be among the reasons why diuretics were not used as antihypertensive regimens.Conclusions The usage rate of diu-retics in hypertensive patients in communities of Huai'an City,Jiangsu Province is relatively low.Patients with low educational level,living alone and with higher level of diastolic blood pressure are more likely to use diuretics,while patients who contracted family doctors services and had complication are less inclined to use diuretics.Most GPs be-lieve that diuretics have good therapeutic effects,but due to the wide variety of antihypertensive drugs available,sig-nificant side effects of diuretics,and lack of significant price advantages,diuretics are generally not preferred or used alone.
diureticshypertensioninfluencing factorsblood pressure control rate
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