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Journal of the Korean Academy of Family Medicine 2006;27(9):706-712.
Published online September 10, 2006.
Selection of Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang-Gyeongju Primary Care Research Network.
Chul Won Jang, Ki Hoon Ha, Nak Jin Sung, Dong Wook Lee, Kyung Rae Cho, Sook Heong Jung, Seok Choi, Jae Man Ki, Sung Woo Kim, Kyung Ja Choi, Dong Ik Kim, Joon Seok Song, Young Kyu Choi, Hee Nam Song, Ki Heum Park
1Department of Family Medicine, Dongguk University College of Medicine, Korea. Parkkh@dumc.or.kr
2Pohang-Gyeongju Primary Care Research Network, Korea.
당뇨병이 동반된 고혈압 환자에 대한 항고혈압제 선택 -포항·경주 1차 의료 연구망을 중심으로-
장철원,하기훈,성낙진,이동욱,조경래,정숙형,최석,기재만,김성우,최경자,김동익,송준석,최영규,송희남,박기흠
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Abstract
Background
: Angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker is usually recommended for hypertensive patients with diabetes mellitus. No reports have been made on antihypertensive agents prescribed for these patients in private practice.

Methods : During a one month period of December 2004, 169 hypertensive patients with diabetes mellitus on their prescribed antihypertensive agents by ten family physicians were analyzed. The influencing factors for such prescriptions were analyzed by directly visiting each physicians who prescribed them.

Results : A total of 21 antihypertensive agents were prescribed by these family physicians. Single calcium channel blocker therapy was the most common with 55 cases (32.5%), followed by 20 cases (11.8%) of single angiotensin converting enzyme inhibitor therapy and 16 cases of single therapy of Angiotensin II type 1 receptor blocker. The low frequency of prescribing the Angiotensin II type 1 receptor blocker was due to insufficient effect (7), lack of information (5), resistance from the patients from changing the medications (4) and expensive costs (4).

Conclusion : In prescribing antihypertensive agents for patients with diabetes mellitus, angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker were chosen less. In order to decrease the incidence of complications in these patients, such agents should be prescribed more.
Key Words: diabetes mellitus, hypertension, angiotensin converting enzyme inhibitor, angiotensin II type 1 receptor blocker
초록
연구배경 : 당뇨병이 동반된 고혈압 환자에 대한 항고혈압제는 angiotensin converting enzyme inhibitor 또는 angiotensin II type 1 receptor blocker가 일차선택약제로 권고되고 있다. 그러나 지역사회 개원 가정의가 당뇨병이 동반된 고혈압 환자에게 처방하는 항고혈압제에 관한 연구는 없다.

방법 : 2004년도 12월 한 달 동안 10명의 개원 가정의가 당뇨병이 동반된 고혈압 환자 169명에게 투약한 처방전을 분석하였다. 분석 후 직접 10명의 개원 가정의를 방문하여 약물의 선택에 영향을 미친 요인에 대해 조사하였다.

결과 : 항고혈압제 처방은 총 21가지였다. Calcium channel blocker 단독요법이 55예(32.5%)로 가장 많았다. Angiotensin converting enzyme inhibitor 단독요법이 20예(11.8%), Angiotensin II type 1 receptor blocker 단독요법이 16예(9.5%)였다. Angiotensin II type 1 receptor blocker 사용빈도가 낮은 이유로는 불충분한 강압효과가 7명, 부족한 약품 정보 5명, 약제 변경에 대한 환자의 저항감 4명, 비싼 약값 4명이었다.

결론 : 당뇨병이 동반된 고혈압 환자에 대한 항고혈압제로서 angiotensin converting enzyme inhibitor 또는 angiotensin II type 1 receptor blocker의 선택이 적었다. 당뇨병이 동반된 고혈압 환자에서 합병증 발생을 줄이기 위하여 angiotensin converting enzyme inhibitor 또는 angiotensin II type 1 receptor blocker가 더 많이 선택되어야 하겠다.
중심 단어: 당뇨병, 고혈압, angiotensin converting enzyme 억제제, angiotensin II 수용체 길항제


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