Retrospective, Observational, Longitudinal Study of Drug Utilization for the Treatment of Uncomplicated Essential Hypertension in Bulgaria

Objective: To evaluate drug utilization and assess rational drug use in the treatment of patients with uncomplicated essential hypertension in Bulgaria, using quantitative and qualitative measures at national level. Design and method: Retrospective, observational, longitudinal study of data from the public registers of the National Health Insurance Fund for the period 2017-2021 using the WHO ATS/DDD methodology and descriptive statistical methods. Results: The analyzed population included 129 312 patients with uncomplicated essential hypertension /I10/ - 11.09% of all hypertensive patients in Bulgaria. The average cost per year was 8 229 567.10 BGN (1 Euro=1.95583 BGN) - respectively the cost per patient per year was 63.64 BGN, the monthly cost was 5.30 BGN and the cost per day was 0.17 BGN. The amount of 8 229 567.10 BGN was divided into two groups - costs for mono-products (67.73%) and costs for combined products (32.27%). The analysis of the actual therapeutic practice in Bulgaria showed that the most prescribed products for this indication were beta-blockers Nebivolol and Bisoprolol, calcium channel blocker Lercanidipine and centrally acting anti-adrenergic agents Moxonidine and Rilmenidine. Sartans were represent predominantly by Telmisartan. In all cross-sectional analyses, the significant use of Lercanidipine was very prominent. Regarding the fixed-dose combinations, medicinal products, containing AT1-blocker and thiazide diuretic were preferred choice for treatment - the most prescribed combination was Valsartan with Hydrochlorothiazide (15.93% of the reimbursement costs for fixed-dose combinations). Conclusions: Despite of the clear recommendation in the guidelines, monotherapy was still preferred treatment for uncomplicated essential hypertension /I10/ in Bulgaria, during the studied period /2017-2021/. We must persist with the continuous education of the GPs, in order to improve the therapy and control of the arterial hypertension in Bulgaria.