Drug Utilization Patterns of Anti Hypertensive agents in patients undergoing Hemodialysis in a Tertiary Care Hospital

Abstract

Background: India is experiencing a rapid health transition and is projected to become a major reservoir of chronic diseases like Diabetes and Hypertension and 25 to 40% of these subjects may develop chronic kidney disease and end stage renal disease. Aim and objective of the study was to analyze utilization pattern of antihypertensive drugs in chronic kidney disease patients in a tertiary care hospital. Methods: The present observational cross-sectional study was conducted in Apollo hospitals, Jubilee hills, Hyderabad from 01.12.2019 to 31.05.2020 on patients with chronic kidney disease stage 5. The drug utilization pattern was studied with respect to age, sex, basic disease, duration of dialysis, type of antihypertensives used, etc. Comparison of mean between gender and dialysis / not on dialysis was done using unpaired ‘t’ test. A p value of < 0.05 was taken as statistically significant. Results: Of 100 patients, the data was analyzed with respect to age categories between 18-30 years; 31-40; 41-50; 51-60; 61-70; >70 years which accounted for 10%, 11%, 20%, 35%, 21% and 3% respectively. The patients between age group between 51-60 years were more prevalent compared to other age groups, based on gender distribution, majority of sample size were found to be males (62%) followed by females (38%). In our study sample, few subjects were found to be Overweight and obese subjects accounted for 33% and 20% respectively followed by subjects with normal BMI 44% and Underweight 3%.Almost all the subjects had Comorbidities. The profound ones were Dyslipidemia, Diabetes mellitus, Hypothyroid, CAD. The contribution of hypertension to medical morbidity and mortality is therefore enormous as it has been shown in other studies with stroke, anemia, Type 2 DM, and renal failure. It is the most common associated comorbid condition among many medical admissions. Most clinicians are often guided by their preference for any of the major guidelines available for the management of hypertension. Previously, diuretics were considered to be the first-line drugs. However, guidelines by the JNC VII recommend both CCBs as well as ACE-I as first-line drugs in addition to diuretics. Conclusions: In order to treat CKD, it is important to treat hypertension as hypertension and CKD are related to each other. Treatment of hypertension will help in controlling future development of comorbidities. Calcium channel blockers and centrally acting drugs are the treatment of choice in patients with CKD stage 5D with hypertension. Multi-drug antihypertensive therapy is a better choice than mono/single-drug antihypertensive therapy.