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Introduction <p>Hypertensive crises are often managed in primary care, yet guideline-discordant use of short-acting oral antihypertensives remains common in low- and middle-income countries.</p> Aim <p>We aimed to describe prescribing patterns of captopril, nifedipine, furosemide, and metamizole in Peru.</p> Methods <p>We conducted a retrospective cohort study using nationwide data from the Peruvian Seguro Integral de Salud (2019–2024). Adults with hypertension and at least one hypertensive crisis episode (systolic blood pressure [BP] ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg) in primary care were included. Joinpoint regression assessed temporal trends, and multivariable logistic regression identified prescribing determinants.</p> Results <p>We analyzed 163,166 episodes from 101,894 patients (mean age 67.3 ± 13.7 years, 60.9% women). Captopril use declined from 40.3 to 34.5% (average monthly percent change [AMPC] − 0.22%; <i>p </i>&lt; 0.001), with steepest decreases in level I-1 healthcare facilities and patients ≥ 80 years. Nifedipine showed no significant overall change (AMPC + 0.07%; <i>p </i>= 0.406) but rose mid-period before declining. Combined captopril or nifedipine use decreased modestly (AMPC − 0.21%; <i>p </i>&lt; 0.001). Furosemide or metamizole were prescribed in 4.7% of episodes, with stable trends but increases in level I-1 healthcare facilities. Higher systolic BP increased the probability of prescribing all medications; diastolic BP showed a non-linear association peaking at 100–110 mmHg. Younger ages were associated with greater medication use.</p> Conclusions <p>Short-acting antihypertensives and other agents remain common in Peruvian primary care hypertensive crises. Targeted strategies are needed to align practice with evidence-based recommendations.</p>

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Treatment of Hypertensive Crisis in Primary Care Health Facilities in Peru, 2019–2024

  • 期刊论文

  • 发表日期：

    2025年11月21日

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  • Carlos Diaz-Arocutipa

摘要

Introduction

Hypertensive crises are often managed in primary care, yet guideline-discordant use of short-acting oral antihypertensives remains common in low- and middle-income countries.

Aim

We aimed to describe prescribing patterns of captopril, nifedipine, furosemide, and metamizole in Peru.

Methods

We conducted a retrospective cohort study using nationwide data from the Peruvian Seguro Integral de Salud (2019–2024). Adults with hypertension and at least one hypertensive crisis episode (systolic blood pressure [BP] ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg) in primary care were included. Joinpoint regression assessed temporal trends, and multivariable logistic regression identified prescribing determinants.

Results

We analyzed 163,166 episodes from 101,894 patients (mean age 67.3 ± 13.7 years, 60.9% women). Captopril use declined from 40.3 to 34.5% (average monthly percent change [AMPC] − 0.22%; p < 0.001), with steepest decreases in level I-1 healthcare facilities and patients ≥ 80 years. Nifedipine showed no significant overall change (AMPC + 0.07%; p = 0.406) but rose mid-period before declining. Combined captopril or nifedipine use decreased modestly (AMPC − 0.21%; p < 0.001). Furosemide or metamizole were prescribed in 4.7% of episodes, with stable trends but increases in level I-1 healthcare facilities. Higher systolic BP increased the probability of prescribing all medications; diastolic BP showed a non-linear association peaking at 100–110 mmHg. Younger ages were associated with greater medication use.

Conclusions

Short-acting antihypertensives and other agents remain common in Peruvian primary care hypertensive crises. Targeted strategies are needed to align practice with evidence-based recommendations.