The pattern of antihypertensive medication use among elderly patients in a tertiary care teaching hospital in South India

Abstract

Background: The blood pressure (BP) control rates in elderly patients remain low and hypertension in them is a management dilemma to the treating physician. Objective: The primary objective of this study was to characterize the prescribing pattern of antihypertensive agents among elderly patients in a tertiary care teaching hospital. Materials and Methods: This study was part of a larger cross-sectional retrospective study to assess the pattern of prescribing for inpatient hypertensive cases in the Inpatient Department of General Medicine at Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH), Perambalur (Tamil Nadu). The data were collected for a period of 10 months. Only elderly patients who are 65 and above and those who were suffering from essential hypertension and had been prescribed at least one antihypertensive drug with or without other co-morbid conditions were included. Results: Among 106 patients studied, approximately 51% and 49% were on monotherapy and combination therapy, respectively. The antihypertensive drugs were prescribed alone or in combination in the following order: Calcium channel blockers (CCBs), diuretic, beta blockers (BBs), ACE inhibitors (ACEIs), and angiotensin receptor blockers (ARBs). The commonest monotherapy agents prescribed were CCBs (29.2%), followed by diuretic (11.3%), ACEI (4.7%), BB (4.7%), and ARBs (0.9%). The most prevalent two-drug therapy was with a CCB and diuretic (19.8%), followed by a CCB and BB (7.5%), CCB and ACEI (1.9%), ACEI and diuretic (2.8%), CCB and ARB (1.9%), BB and diuretic (1.9%), BB and ACEI (0.9%), and BB and ARB (0.9%). The commonest three-drug therapy was with a CCB, BB, and diuretic (2.8%). Other three-drug therapies were an ACEI + CCB + BB (0.9%), an ARB + diuretic + CCB (0.9%), a BB + CCB + ARB (0.9%), a BB + ACEI + diuretic (0.9%), a BB + ARB + diuretic (0.9%), and a CCB + diuretic + ACEI (0.9%). The commonest four-drug therapy was with a CCB, BB, ARB, and diuretic (1.9%) followed by a CCB + BB + ACEI + diuretic (0.9%). Conclusion: The most commonly prescribed antihypertensive drug was CCBs followed by diuretics, BBs, ACEIs, and ARBs. Overall, there was less utilization of diuretics and ACEIs or ARBs.