Antihypertensive prescription among black patients without compelling indications: prescription, effectiveness, quality and cost of medication

Onyinye Onyeka Akunne,Aduragbenro Deborah A Adedapo

doi:10.1186/s12913-019-4202-2

Onyinye Onyeka Akunne, Aduragbenro Deborah A Adedapo

Open Access

https://doi.org/10.1186/s12913-019-4202-2

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Abstract

BackgroundHypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications.MethodPatients with uncomplicated hypertension attending three clinics in the University College Hospital, Ibadan in Nigeria were recruited into this study. Information on demographics, antihypertensive medication prescribed, blood pressure measurements, and cost of medications were collected for each patient. Antihypertensive medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) system. The frequency of usage of each drug class and their prescribed doses per patient/day were calculated and compared with the DDD to assess the quality of prescription. Cost of antihypertensive medication was calculated for each patient and reported as cost per patient/day and cost per patient/month. Effect of variables on BP control was ascertained. Statistical analyses were done using SPSS, chi-square and correlation test was used to test for associations.ResultA total number of 1050 hypertensive patients were included in this study. The mean age was 60 years, females made up 62% of the study population. A high level of polypharmacy (87%) and sub-optimal blood pressure control was observed. An increase in blood pressure was observed with increase in the number of medication prescribed (χ2 = 33.618, p < 0.001; r = .18, p < 0.001). The most prescribed antihypertensive medication either as a single therapy or a fixed-dose combination was diuretic. About 54% of the prescribed daily doses of antihypertensive medication exceeded the DDD. The total monthly expenditure on antihypertensive drugs was approximately N3.2 million ($15,300).ConclusionStudy findings show a high level of polypharmacy and non-generic prescribing. Increased prescribing of drugs that are cost-effective, as well as prescription of fixed dose combinations (FDCs), is recommended in hypertensive patients. This is necessary to control blood pressure while increasing treatment adherence.

Highlights

Hypertension remains one of the leading causes of death in Nigeria
Blood pressure control was poor with only 35% of the patients achieving optimum blood pressure values (Table 1)
Prescription pattern and quality Patients had as many as 5 antihypertensive drugs prescribed; 19 patients were on non-pharmacological therapy

Summary

Introduction

Hypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications. Hypertension is a global cause of morbidity and mortality [1]. A large proportion of individuals affected with hypertension are unaware of their status [2]. Hypertension is frequently complicated by other diseases [4]. In patients with uncomplicated hypertension, stringent blood pressure lowering measures together with adequate monitoring is required. This will prevent complications that may lead to end-organ damage

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