Availability of antihypertensive medications at municipal municipal first care level in the city of Córdoba (Argentina) during the year 2019

Abstract

Access to essential medicines is a health challenge. Availability is a dimension of access, defined as the relation between the amount and type of resources offered and the needs of patients. This study examines the availability of antihypertensive medications in municipal health centers in the city of Córdoba, during 2019.

The Defined Daily Dose (DDD) - a technical measure recommended by the WHO - was used to quantify the active ingredients available. This was revised to check if they respond to the recommendations for the management of high blood pressure (HTN) of the National Health Ministry. The requirements were calculated according to the population registered in the municipal HBP program, considering consumption habits identified in the Pure and Renata II studies, which estimate 1.3 DDD/per day/per patient in relation to antihypertensive drugs. The availability rate was calculated for every 100 patients in the program per day (DDD 100ptesP-day): Amount of active ingredient in DDD/year x 100 divided by DDD x 365 x total patients in Program. Data source: Directorate of Primary Health Care (epidemiology area and drug distribution center); Remediar program integrated logistics and medications system.

In 2019, 8,811 patients registered under the program required 4,180,701 DDD annually, a rate of 130 DDD 100ptesP-day. However, the annual availability was 3,281,075 DDD, resulting in 102 DDD 100ptesP-day, which represented 78% of the requirements. The active ingredients available were: 47% enalapril, 30% amlodipine, 9% atenolol, 9% hydrochlorothiazide, 4% losartan and 1% furosemide.

Although all recommended therapeutic groups (ACEI, ARB, calcium blockers, thiazides) were provided, the high availability of enalapril, despite recommendations to prioritize hydrochlorothiazide or losartan due to their better therapeutic results, could be due to entrenched prescription practices. The inclusion of furosemide and beta-blockers could respond to the treatment of comorbidities - for which they are recommended - but this could not be verified. The low registration of patients compared to HTN prevalence estimates makes it essential to strengthen coverage and information management strategies to guarantee an appropriate number of medications, prioritizing those with best clinical evidence.