Comparative analysis of the structure of prescriptions for fixed combinations of antihypertensive drugs containing diuretics

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Introduction. For many years, cardiovascular diseases (CVD) have been one of the main causes of death in many countries of the world, and arterial hypertension (AH) is the most common disease of this group. People suffering from hypertension are at high risk of developing cardiovascular complications such as myocardial infarction, stroke of the brain and other diseases of the heart and circulatory system. Thus, the attending physician faces this task of using fixed combinations of antihypertensive drugs.
The aim of the work is to conduct a comparative analysis of the structure of prescriptions of fixed combinations of antihypertensive drugs containing diuretics
Materials and methods of research. The structure of the pharmaceutical market in different cities differs from each other to one degree or another. Each doctor sets a task for himself – to select the combined drug as individually as possible to improve the patient's condition and for the convenience of its use. A comparative analysis of the structure of the market of antihypertensive medicines in pharmacies in the cities of Kursk, Orel, Kaluga, Bryansk and Smolensk for 2021-2022 was carried out. The structure of consumption of combined drugs by patients with arterial hypertension in the cities indicated above in kind (in packages), grouped by INN for 2021, is presented in Table 1. The complex task of achieving the main goals of antihypertensive therapy: improving the prognosis of the disease and the patient's life, as well as improving the quality of life of the patient. An inevitable solution [1, 2].

Table 1.

The structure of consumption of combined drugs by patients with arterial hypertension in the cities of Kursk, Orel, Kaluga, Bryansk and Smolensk in kind (in packages), grouped by INN for 2021.

INN Area No.
Bryansk Kaluga Kursk Orel Smolensk
1 indapamide + perindopril 35.65% 22.29% 15.54% 14.84% 28.02%
2 telmisartan + hydrochlorothiazide 18.61% 18.45% 4.51% 3.68% 16.89%
3 azilsartan medoxomil + chlorthalidone 3.97% 5.29% 7.46% 15.42%
4 indapamide + enalapril 8.37% 8.90% 1.70% 0.55% 8.14%
5 indapamide + lisinopril 0.21% 0.53% 0.72% 1.45%
6 lisinopril + hydrochlorothiazide 1,21% 1,50% 0,91% 0,86% 1,21%
7 amlodipine + indapamide 0.87% 1.20% 0.59% 1.41% 1.05%
8 losartan + hydrochlorothiazide 1.20% 5.46% 9.86% 9.02% 0.82%
9 Amlodipine + valsartan + hydrochlorothiazide 0.73% 1.11% 1.19% 1.05% 0.76%
10 bisoprolol + hydrochlorothiazide 0.50% 2.44% 3.56% 0.66%
11 amlodipine + indapamide + lisinopril 0.54% 0.61% 0.62%
12 ramipril + hydrochlorothiazide 0.52% 0.43% 0.17% 0.53%
13 enalapril + hydrochlorothiazides 1.24% 4.99% 6.39% 4.22% 0.51%
14 candesartan + hydrochlorothiazide 0.23% 0.12% 0.28% 0.38%
15 irbesartan + hydrochlorothiazide 0.23% 0.63% 0.16% 0.22%

A comparative analysis of the structure of the antihypertensive drugs market in pharmacies in the same cities in 2022 was also carried out.
The structure of consumption of combined drugs by patients with arterial hypertension in the cities of Kursk, Orel, Kaluga, Bryansk and Smolensk in kind (in packages), grouped by INN for 2022, is shown in Table 2.

Table 2.

The structure of consumption of combined drugs by patients with arterial hypertension in the cities of Kursk, Orel, Kaluga, Bryansk and Smolensk in kind (in packages), grouped by INN for 2022.

INN Area No.
Bryansk Kaluga Kursk Orel Smolensk
1 indapamide + perindopril 23.29% 20.45% 16.35% 13.81% 15.73%
2 azilsartan medoxomil + chlorthalidone 12.77% 5.40% 5.76% 7.29% 15.28%
3 amlodipine + indapamide + perindopril 12.57% 15.52% 13.06% 9.47% 10.36%
4 losartan + hydrochlorothiazide 6,56% 11,57% 8,45% 8,54% 9,37%
5 atenolol + chlorthalidone 3.95% 3.76% 4.44% 4.66% 4.90%
6 telmisartan + hydrochlorothiazide 2.09% 3.45% 5.11% 4.13% 3.70%
7 enalapril + hydrochlorothiazides 4.81% 4.15% 5.66% 4.04% 3.08%
8 valsartan + hydrochlorothiazide 3.29% 3.16% 3.75% 4.05% 2.19%
9 indapamide + enalapril 0,59% 0,66% 1,24% 0,38% 1,62%
10 indapamide + lisinopril 0.23% 0.70% 1.08% 1.4 %
11 amlodipine + indapamide 0.88% 1.39% 0.66% 1.92% 0.99%
12 amlodipine + valsartan + hydrochlorothiazide 0.97% 1.24% 1.55% 1.30% 0.98%
13 lisinopril + hydrochlorothiazide 1.12% 1.30% 0.68% 0.94% 0.91%
14 amlodipine + indapamide + lisinopril 0.18% 0.59% 0.59% 0.87%
15 bisoprolol + hydrochlorothiazide 1.49% 0.48% 2.00% 3.20% 0.67%

The results of the study. From the data in table 1, it is clearly visible that in physical terms, among the fixed combinations for 2021, the combination "indapamide + perindopril" was most often used in all the regions represented, but also in the Bryansk, Kaluga and Smolensk regions, the combination "telmisartan + hydrochlorothiazide" is quite often purchased. From the data in table 2, it is clearly visible that in physical terms, among the fixed combinations for 2022 in all the regions represented, the combination "indapamide + perindopril" was most often used, as well as in 2021. However, the combination of three drugs "amlodipine + indapamide + perindopril" began to occupy the second place in the Kaluga, Kursk and Oryol regions, and the same combination occupies the third place in the Bryansk and Smolensk regions [3, 4].
Conclusion. As a result of the analysis of the market of hypertensive drugs for 2021 and 2022 within the studied areas, the following conclusions can be drawn:
1. The most popular combination of drugs for 2021 and 2022 in kind (in packages) is "indapamide + perindopril" - "ACE inhibitor + diuretic".
2. Drugs with such pharmacotherapeutic groups were the least popular: "BMCC + diuretic".
3. The most popular drugs in 2021 were drugs with the following pharmacotherapeutic groups: "ACE inhibitor + diuretic", "BRA2 + diuretic" and "ARA2 + diuretic".
4. The most popular drugs in 2022 were drugs with the following pharmacotherapeutic groups: "ACE inhibitor + diuretic", "BRA2 + diuretic", "ARA2 + diuretic" and "ACE inhibitor + diuretic + BCC".

About the authors

Arsen Аleksandrovich Kornilov

Kursk State Medical University

Author for correspondence.
Email: drarsmen@mail.ru
ORCID iD: 0000-0002-0197-9826

Associate Professor of the Department, Candidate of Medical Sciences

Russian Federation, Курская область, город Курск, ул. Карла Маркса, д. 3.

Olga Vladimirovna Rogova

Kursk State Medical University

Email: Olg.Synkova@yandex.ru

student

Russian Federation, 305041. K.Marx,3, Kursk.

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