Factors Associated With the Selection of Anti-Hypertensive Medications: A Retrospective Cross-Sectional Analysis.

Background: Hypertension increases the risk of complications in patients with diabetes. Race/ethnic differences in the uptake of antihypertensive medications may contribute to disparities in clinical outcomes, but this has not been formally evaluated. We aimed to assess patterns of antihypertensive medication prescription by race/ethnic group and the association with clinical outcomes among hospitalized diabetic patients with hypertension. Methods: This was a 1 year prospective study of individuals with existing diabetes and hypertension (N=1126, 42% black/Hispanic [minority]; 39% female) that participated in an NHLBI clinical outcomes study of patients admitted to a cardiovascular service. Baseline clinical/medication data and outcomes (rehospitalization/death) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity, antihypertensive prescription, and outcomes adjusted for demographics/comorbidities. Results: Overall utilization of antihypertensive medication prior to admission did not differ between minority (92%) vs. white/other (93%) patients; minorities were more likely to report taking calcium channel blockers (OR=1.40;95%CI=1.08-1.81) and less likely to use beta blockers (OR=0.65;95%CI=0.50-0.84) vs. whites/others. Race/ethnic differences in prescription type did not persist at discharge after adjustment for demographics/comorbidities (96% prescribed any antihypertensive medication: 62% ACE inhibitor/ARB, 81% beta blocker, 29% calcium channel blocker, 48% diuretic). A total of 676 (60%) of participants were rehospitalized/dead at 1 year; predictors of rehospitalization/death included minority race/ethnicity, lack of health insurance, renal failure/dialysis, peripheral vascular disease, and heart failure (p<0.05). Prescription of beta blocker (OR=0.60;95%CI=0.43-0.82) was associated with lower odds of rehospitalization/death at 1 year. Race/ethnic minority status remained a significant predictor of death/rehospitalization at 1 year after adjustment demographics, comorbidities and beta blocker prescription at discharge (OR=1.31;95%CI=1.01-1.71). Conclusion: In this study of hospitalized diabetic patients with hypertension, antihypertensive prescription at discharge did not vary by race/ethnicity; beta blocker prescription at discharge was associated with lower odds of rehospitalization/death at 1 year. Higher odds of rehospitalization/death among minorities was not explained by measured covariates including type of antihypertension medication.

Haemodialysis patients were studied in 12 countries to identify practice patterns of prescription of antihypertensive agents (AHA) associated with survival. The sample included 28 513 patients enrolled in DOPPS I and II. The classes of AHA studied were beta blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), peripheral blocker, central antagonist, vasodilator, long-acting dihydropyridine calcium channel blocker (CCB), short-acting dihydropyridine CCB and non-dihydropyridine CCB. To reduce bias due to unmeasured confounders, the associations with mortality were assessed by separate Cox models based on patient-level prescription and facility prescription practice. An increase in prescription of ARBs (9.5%) and BBs (9.1%) was observed from DOPPS I to II. Prescription of AHA classes varied significantly by country, ranging for BBs from 9.7% in Japan to 52.7% in Sweden and for ARBs from 5.5% in Italy to 21.3% in Japan in DOPPS II. Facilities that treated 10% more patients with ARBs had, on average, 7% lower all-cause mortality, independent of patient characteristics and the prescription patterns of other antihypertensive medications (P = 0.05). Significant and independent associations with reduction in cardiovascular mortality were observed for ARBs (RR = 0.79; P = 0.005) and BBs (RR = 0.87, P = 0.004) in analyses of patient-level prescriptions. These associations in the facility-level model followed the same direction. DOPPS data show large variations across countries in AHA prescription for haemodialysis patients. The data suggest an association between ARB use and reduction in all-cause mortality, as well as with the use of BBs and reduction in cardiovascular mortality among haemodialysis patients.

As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient's first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings. Data on patient demographics, diagnosis, prescription pattern, payment mode and follow-up was extracted from a cross-sectional study involving 122 public primary care clinics and 652 private primary care clinics in Malaysia. Encounters with hypertensive patients aged ≥ 60 years were included. A total of 1,017 antihypertensive medications were prescribed - calcium channel blockers (27.1%), beta blockers (25.5%), diuretics (23.3%), angiotensin-converting enzyme inhibitors (14.9%) and angiotensin receptor blockers (6.3%). Out of the 614 patient encounters, 53.1% of the patients were prescribed monotherapy, 31.6% were prescribed dual therapy, 12.2% triple therapy, 2.8% quadruple therapy and 0.3% quintuple therapy. Type of primary care clinic and payment mode were significant predictors for the prescription of combination therapy and fixed-dose combination therapy, respectively. Four types of inappropriate prescriptions were identified. Calcium channel blockers were the most common antihypertensive drug prescribed and more than half of the elderly patients were on monotherapy. Antihypertensive drug prescription was found to be associated with the type of primary care clinic and the payment mode, suggesting that prescription is influenced by the cost of the drug.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension

The exponential increase in patients with hypertension puts an enormous burden on healthcare providers. To describe the trends in the prescription of antihypertensive medication in a tertiary care hospital, Bangladesh is the objective of the study. This is a hospital based descriptive cross sectional study conducted at the Medicine outpatient Department in Dhaka Medical College Hospital. Patients more than 20 years of age suffering from Hypertension were included in the study. Data was collected by interviewing using a semi-structured questionnaire and analysed by computer with the help of SPSS 16. A total hundred patients were included in the study and 61.6% patients were prescribed on single drug and 38.4% patients were prescribed on combined therapy. Among the prescriptions having single anti-hypertensive medication most commonly used drugs are Angiotensin Receptor Antagonist (37.3%), Calcium Channel Blocker (32.8%), and ACE Inhibitor (17.9%), Beta Blocker (6%), Alpha Blocker (3%), Thiazide and non-Thiazide Diuretics 1.5% each. Among the prescriptions having combined drug therapy Angiotensin Receptor Blocker along with Calcium Channel Blocker and Calcium Channel Blocker along with Beta Blocker were equally (28.1%) chosen by the physicians and use of Angiotensin Receptor Blocker along with Diuretics was 25%, ACE Inhibitor with Calcium Channel Blocker 3.1%, ACE Inhibitor with Diuretics 3.1%, Thiazide and Non Thiazide Diuretics was 3.1% and other drugs were used for 9.5%. Pattern of using antihypertensive medications varies according to presence of co-morbidities and duration but does not vary significantly between male and female patients. Key words: Anti-hypertensive drugs, hypertension, prescription pattern, management of hypertension.

BackgroundHypertension is a major global public health concern and a leading risk factor for cardiovascular, cerebrovascular, and renal diseases. Despite the availability of evidence-based guidelines for hypertension management, discrepancies often exist between recommended practices and real-world prescribing patterns. This study aimed to evaluate the prescription pattern of antihypertensive drugs in patients attending the outpatient department (OPD) of medicine at a tertiary care hospital and to assess the adherence of prescribed therapies to the Eighth Joint National Committee (JNC 8) guidelines.MethodsThis was a cross-sectional, single-center, observational study conducted over two years, with data collection spanning six months (April to September 2023) in the OPD of medicine of a tertiary care hospital. A total of 334 patients diagnosed with primary hypertension, meeting the inclusion criteria, were enrolled after obtaining informed consent. Data were collected from printed hospital management information system (HMIS)-generated prescriptions, which included diagnosis, past history, and antihypertensive treatment, along with patient interviews. Data regarding demographics, comorbidities, and antihypertensive prescriptions were collected and analyzed. Prescriptions were also evaluated for adherence to JNC 8 guidelines.ResultsAmong 334 patients, 182 (54.49%) were male and 152 (45.51%) were female, with a mean age of 57.2 ± 11.39 years. The majority (57.49%) belonged to the 40-60 years age group. A total of 536 antihypertensive drugs were prescribed, with an average of 1.60 ± 0.65 drugs per prescription. Among the 334 prescriptions analyzed, calcium channel blockers (CCBs) were the most commonly prescribed class (76.95%), followed by angiotensin receptor blockers (ARBs) (60.18%), diuretics (27.25%), beta-blockers (BBs) (18.26%), angiotensin-converting enzyme inhibitors (ACEIs) (5.99%), and alpha-blockers (0.6%). Monotherapy was prescribed in 36.23% of cases, while 63.77% received combination therapy, with two-drug combinations being most common (41.62%). Among monotherapy prescriptions, CCBs were preferred (71.9%), followed by ARBs (20.66%). The most frequent two-drug combination was CCB + ARB (61.87%), while the three-drug combination of CCB + ARB + diuretic was most common (60.66%). In four-drug combinations, CCB + ARB + BB + diuretic was most frequently used (76.93%). Comorbidities were present in 52.69% of patients, with diabetes mellitus (68.18%) being the most prevalent. In diabetic hypertensive patients, CCBs (80.83%) were most commonly prescribed; 82.63% of prescriptions adhered to JNC 8 guidelines.ConclusionThe study revealed a high prevalence of CCB and ARB use, both as monotherapy and combination therapy, in accordance with national and international guidelines. However, prescribing trends were influenced by factors such as physician preference, comorbidities, and individual clinical judgment. Regular prescription audits and awareness programs focusing on evidence-based guidelines are essential to ensure rational antihypertensive drug use and optimal patient outcomes.

Management of Hypertension in Patients With Diabetic Kidney Disease: Summary of the Joint Association of British Clinical Diabetologists and UK Kidney Association (ABCD-UKKA) Guideline 2021

A Fixed-Dose Combination of Bisoprolol and Amlodipine for Hypertension: A Potential Benefit to Selected Patients.

To investigate the prevalence of and indications for digoxin use and the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension in an academic hospital-based geriatrics practice. A retrospective analysis of charts from 528 unselected older patients, seen from June 1995 through July 1996 at an academic hospital-based geriatrics practice, was performed to investigate the prevalence of digoxin use and indications for digoxin use, the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension. An academic hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. A total of 416 women and 112 men, mean age 81 +/- 8 years (range 58 to 101), were included in the study. Ninety-two of the 528 patients (17%) were taking digoxin. Recorded indications for digoxin were atrial fibrillation with or without congestive heart failure (CHF) in 39% of patients, CHF with sinus rhythm and abnormal left ventricular ejection fraction (LVEF) in 18% of patients, a clinical assessment of CHF with sinus rhythm and no recorded measurement of LVEF in 20% of patients, paroxysmal atrial fibrillation in 14% of patients, and coronary artery disease (CAD) in 9% of patients. Of 121 patients with previous myocardial infarction, 23 (19%) were prescribed beta blockers, and 54 (45%) were taking calcium channel blockers. Of 173 patients with CAD, 41 (24%) were treated with beta blockers, and 79 (46%) were taking calcium channel blockers. LVEF was not recorded in the charts of 90 of 121 patients (74%) with prior myocardial infarction and of 125 of 173 patients (72%) with CAD. Of 480 older patients with hypertension, 154 (37%) were treated with diuretics, 55 (13%) were treated with beta blockers, 160 (38%) were treated with ACE inhibitors, and 197 (47%) were treated with calcium channel blockers. In 528 older patients seen in an academic hospital-based geriatrics practice, the prevalence of digoxin use was 19%. Appropriate indications for digoxin were documented clearly in the charts of 53 of 92 patients (57%). Calcium channel blockers were used more often than beta blockers in patients with previous myocardial infarction or CAD. Calcium channel blockers were the most frequently used antihypertensive drugs.

Prescribing patterns of antihypertensive medications: A systematic review of literature between 2010 and 2020

To investigate the current status of blood pressure control rate and the use of antihypertensive drugs in elderly patients with coronary heart disease, diabetes mellitus and hypertension. The elderly coronary heart disease patients with diabetes mellitus and hypertension (≥ 60 years old) were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011 in this multicenter, non-intervention and cross-sectional survey. The current status of blood pressure control rate in different antihypertensive target value, methods for application in antihypertensive drugs and standardized treatment recommended by guideline were investigated in the survey. 1 379 cases were eventually selected from the total 7 962 elderly patients (accounted for 17.3%). (1) The blood pressure control rate was 17.1% for antihypertensive target value (<130/80 mmHg); the control rate for 140/80 mmHg was 27.5%; the control rate for 140/90 mmHg was 39.6%; the success rate for 150/90 mmHg were 51.7%; control rate of elderly patient (≥ 70 years old) gradually increased with increasing of age; success rate of elderly patient (≥ 85 years old) was the highest, whereas control rate of elderly patient aged 71-71 years old was lowest; success rate for male patients was close to female patients, and success rate for men were slightly higher than those in women; (2) 1 347 cases had clear medication history (32 cases were missed) in the survey, 1 317 effective cases received antihypertensive therapy (effective rate was 97.8%, 1 317/1 347); the more commonly used drugs were angiotensin receptor blockers (ARB) /angiotensin converting enzyme inhibitors (ACEI) (usage rate was 76.8%), followed by dihydropyridine calcium channel blockers (CCB) (65.5%), β-blockers (usage rate was 44.6%), thiazide diuretics (26.3%) respectively; (3) combinations of two drugs was the most common way in antihypertensive medication (accounted for 41.2%), three drugs or more was 28.9%, and single drug was 23.9%; CCB was the commonly used single drug (accounted for 8.8%); combinations of CCB and ARB were the most common way in combination of two drugs(11.7%), CCB combined with ARB and β-blockers was frequently used in combination of three drugs or more (9.2%); (4) 987 cases received standardized treatment recommended by guideline (accounted for 76.6%); the percentage of standardized usage in combinations of two drugs was 71.9%, the percentage of standard usage in combinations of three drugs or more was 66.1%. The percentage of antihypertensive therapy is high, however, the overall blood pressure control rate is low. ACEI /ARB are the major drugs in antihypertensive medication, diuretic drugs are now rarely used; combined medication is the common method of antihypertensive therapy; the consciousness following the guidelines has improved, but still need to be strengthened.

Objective: The primary objective of this study was to characterize the prescribing pattern of antihypertensive agents in the tertiary care teaching hospital. The secondary objective of this study was to assess the appropriateness of the prescribing pattern of antihypertensive drugs as per the seventh report of the Joint National Committee (JNC-7) guidelines. Materials and Methods: A cross-sectional, retrospective study for the period of 7 months (June 2012 to January 2013) was conducted. Only inpatient hypertensive cases suffering from essential hypertension with or without other comorbid conditions were included in the study. Results: A total of 261 hypertensive patients on treatment, of which 57.9% were females and 42.1% males, were included. Hypertension alone was present in 26.8% of the patient whereas diabetes mellitus was the most common comorbid condition in 18.8% of the cases. Of the 261 patients studied, 47.1% were on monotherapy and 52.8% on combination therapy. The commonest monotherapy agents being prescribed were calcium channel blockers (CCBs) (26.8%), followed by diuretic (9.6%), angiotensin-converting enzyme inhibitor (ACEI) (5%), beta blockers (BBs) (3.8%) and angiotensin receptor blockers (ARBs) (1.9%). The commonest two drug therapy was with CCB and diuretic (15.7%), followed by CCB and BB (7.3%), CCB and ACEI (4.2%), ACEI and diuretic (3.4%), ARBs and diuretic (2.7%), BBs and diuretic (1.9%). The commonest three drug therapy was with CCBs, BBs, and diuretic (4.2%). Conclusion: The most favored class of antihypertensive drugs, either as monotherapy or combination therapy in hypertensive patients with or without comorbidities was CCBs. There was underutilization of thiazide diuretics, ACEIs and BBs in this study. Overall the general pattern of antihypertensive prescribing in this study is only partly in accordance with the guidelines of JNC-7.

Hypertension Following Kidney Transplantation

Readability of information imprinted in patient information leaflets (PILs) in Saudi Arabia: The case of antihypertensive medications

SummaryBackgroundHypertension is a modifiable risk factor for dementia affecting over 70% of individuals older than 60. Lowering dementia risk through preferential treatment with antihypertensive medication (AHM) classes that are otherwise equivalent in indication could offer a cost-effective, safe, and accessible approach to reducing dementia incidence globally. Certain AHM-classes have been associated with lower dementia risk, potentially attributable to angiotensin-II-receptor (Ang-II) stimulating properties. Previous study results have been inconclusive, possibly due to heterogeneous methodology and limited power. We aimed to comprehensively investigate associations between AHM (sub-)classes and dementia risk using large-scale continuous, real-world prescription and outcome data from primary care.MethodsWe used data from three Dutch General Practice Registration Networks. Primary endpoints were clinical diagnosis of incident all-cause dementia and mortality. Using Cox regression analysis with time-dependent covariates, we compared the use of angiotensin-converting enzyme inhibitors (ACEi) to angiotensin receptor blockers (ARBs), beta blockers, calcium channel blockers (CCBs), and diuretics; and Ang-II-stimulating- to Ang-II-inhibiting AHM.FindingsOf 133,355 AHM-using participants, 5877 (4.4%) developed dementia, and 14,079 (10.6%) died during a median follow-up of 7.6 [interquartile range = 4.1–11.0] years. Compared to ACEi, ARBs [HR = 0.86 (95% CI = 0.80–0.92)], beta blockers [HR = 0.81 (95% CI = 0.75–0.87)], CCBs [HR = 0.77 (95% CI = 0.71–0.84)], and diuretics [HR = 0.65 (95% CI = 0.61–0.70)] were associated with significantly lower dementia risks. Regarding competing risk of death, beta blockers [HR = 1.21 (95% CI = 1.15–1.27)] and diuretics [HR = 1.69 (95% CI = 1.60–1.78)] were associated with higher, CCBs with similar, and ARBs with lower [HR = 0.83 (95% CI = 0.80–0.87)] mortality risk. Dementia [HR = 0.88 (95% CI = 0.82–0.95)] and mortality risk [HR = 0.86 (95% CI = 0.82–0.91)] were lower for Ang-II-stimulating versus Ang-II-inhibiting AHM. There were no interactions with sex, diabetes, cardiovascular disease, and number of AHM used.InterpretationAmong patients receiving AHM, ARBs, CCBs, and Ang-II-stimulating AHM were associated with lower dementia risk, without excess mortality explaining these results. Extensive subgroup and sensitivity analyses suggested that confounding by indication did not importantly influence our findings. Dementia risk may be influenced by AHM-classes’ angiotensin-II-receptor stimulating properties. An RCT comparing BP treatment with different AHM classes with dementia as outcome is warranted.Funding10.13039/100009647Netherlands Organisation for Health, Research and Development (ZonMw); 10.13039/100016064Stoffels-Hornstra Foundation.