Study on the Medication Status and Influencing Factors of Hypertensive Patients in the Rural Areas of Jieshou City：Based on Family Doctor Contract Services

Abstract: Background  Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently，there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services. Objective  To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City，Anhui Province，to describe the association between patient medication behavior and patient characteristics，to explore the influencing factors of medication adjustment，and to analyze the rationality of medication use in primary hypertensive patients. Methods  Using cluster sampling，from July to August 2021，48 administrative villages were randomly selected from Jieshou City，Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level（2020 Edition）"，the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories：category A includes angiotensin-converting enzyme inhibitors（ACEIs）and angiotensin receptor blockers（ARBs），category B includes beta-blockers，category C includes calcium channel blockers（CCBs），category D includes diuretics，and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study，"combination medication" refers to taking a combination drug or two or more antihypertensive drugs，and "medication adjustment" refers to patients previously taking other antihypertensive drugs. Results  A total of 3，005 hypertensive patients were included in this study，including 1 291 males（43.0%）and 1 714 females（57.0%），with an average age of（65.5±9.8）years. The medication rate of hypertension was 79.1%，and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs，the rates of different types of antihypertensive drugs from high to low were（some patients had combination medication）：category E（39.6%），category C（35.1%），category D（20.3%），category A（20.1%），and category B（3.7%）；the most frequently taken antihypertensive drug was compound lisinopril（33.7%）. For patients with an average annual blood pressure ≥ 160/100 mmHg，12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure ≥ 100 mmHg" and "with complications"，the rates of adjusted category A and C antihypertensive drugs increased relatively more；for patients with an average annual "systolic pressure ≥ 160 mmHg" and "without complications"，the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication（OR=1.042，95%CI=1.031-1.053，P<0.001），education level above junior high school（OR=1.488，95%CI=1.195-1.853，P<0.001），combined hyperlipidemia（OR=1.267，95%CI=1.052-1.525，P=0.013），combined cardiovascular complications（OR=1.394，95%CI=1.166-1.667，P<0.001），and combined cerebrovascular complications（OR=1.258，95%CI=1.040-1.522，P=0.018）were promoting factors for medication adjustment in patients，while advanced age（OR=0.980，95%CI=0.971-0.990，P<0.001）was an inhibiting factor for medication adjustment. Conclusion  The medication rate among rural hypertensive patients in Jieshou City is high，mainly involving category E and C antihypertensive drugs. The use of various antihypertensive drugs by primary care physicians is generally reasonable，but the management of medication，especially the application of combination medication strategies for patients with secondary hypertension and those with complications，needs to be improved.