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General and Risk Management, Patient Safety (including: medication errors, quality control)
The effectiveness of angiotensin receptor blocker therapeutic interchange in hospitalised patients
  1. R. Veiga Gutiérrez,
  2. E. Espino Paisán,
  3. J. González-López,
  4. C. Crespo Diz,
  5. M.I. Cadavid Torres
  1. 1Complejo Hospitalario Universitario de Santiago de Compostela, Pharmacy, Santiago de Compostela, Spain
  2. 2University of Santiago de Compostela, Pharmacology, Santiago de Compostela, Spain

Abstract

Background The role of therapeutic interchange (TI) has increased substantially in recent years as a result of the rapid expansion in the number of drugs within similar therapeutic classes.

Purpose To evaluate the effectiveness of the angiotensin receptor blockers (ARB-II) TI protocol used in our hospital.

Materials and methods A retrospective cross-sectional study which included hypertensive patients who were switched to losartan between January and May 2011. Primary response variable: proportion of patients maintaining blood pressure values (BP) within the established therapeutic target for prevention of cardiovascular events (130/80 in patients with diabetes mellitus (DM) or chronic renal failure (CRF) and 140/90 in the rest of the patients). Other variables: difference between BP values the month prior to admission (BP1) and after 8 days of the TI (BP2). The analysis was performed using STATGRAPHICS PLUS 5.1 program. A total of 104 patients were analysed, with a mean age of 75.5 years (range 39–96). There was also a subanalysis of patients with associated risk factors (CRF and/or DM).

Results The analysis of the total population, the BP1 (DBP±SD/SBP±SD) average was 74.6±10.8/138.6±16.9 mm Hg and the BP2 69.9±10.7/131.6±20.5 mm Hg. The proportion of patients who maintained BP values within the established therapeutic goal at home was 39%. After the TI, this proportion increased to 64%. In the subgroup of patients with associated risk factors, the BP-1 was 74.9±11.1/139.0±16.8 mm Hg and the BP-2 67.8±10.9/131.2±22.9 mm Hg. The proportion of patients controlled at home was 21% and 53% after the TI.

Conclusions The effectiveness of TI of ARBs in hypertensive patients studied, including patients with associated risk factors, was high, allowing the BP control not only to be maintained but even improved. The decrease in blood pressure found in our study should be studied further in order to evaluate the effect of better treatment adherence in the hospital compared to home.

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