The Patterns of Antihypertensive Drugs use in Acute Hemorrhagic Stroke Patients

Abstract

Hypertension is the highest risk factor of hemorrhagic strokes. Therefore, controlling blood pressure consistently after a stroke occurrenceis to decrease morbidity and mortality in patients. This study aimed to describe the patterns of antihypertensive drugs use, the effect of antihypertensive drugs administration on patient with high blood pressure, and potential drug related problems that occur in patients with acute hemorrhagic stroke. This study was an observational study with a retrospective method. The population study was hemorrhagic stroke patients with hypertension. The samples were 24 patients diagnosed with acute hemorrhagic stroke who got antihypertensive therapy. The instrument in this study were the patient's medical record data. The data was analyzed descriptively. From the medical record data, we obtained information related to the antihypertensive therapy in patients which included drug selection, route of administration, dose, frequency of administration, and duration of therapy. The first antihypertensive drug given in the acute phase include nicardipine, diltiazem, nimodipin, irbesartan, valsartan, amlodipine, captopril and candesartan. As many as 87.5% of antihypertensive drug administration in patients was in accordance with the doses listed in the PERDOSSI 2011 guidelines and the American Society of Health-System Pharmacists 2011. However, there were some patients who received doses exceeding or less thanthe dosage of literature. This was due to patients’ blood pressure who experiencedsignificant fluctuations and titration of intravenous antihypertensive doses. Changing a single therapy into a combination was done because blood pressure increased. The most common combination of antihypertensive drugs types are amlodipine and valsartan. In addition, drug interactions occur between amlodipine-simvastatin, potassium valsartan, and captopril and antacids. The drug side effects found in 1 patient were tachycardia which might be caused by nicardipine. The administration of antihypertensive drugs therapy in patients with acute hemorrhagic stroke was in accordance with the guidelines of the Indonesian Neurologists Specialist 2011, the American Society of Health-System Pharmacists 2011, and Guidelines for hospital clinical practice. Some of the antihypertensive drugs that commonly given, namely nicardipine, diltiazem, nimodipine, irbesartan, valsartan, amlodipine, captopril and candesartan, and combination antihypertensive drugs, such as amlodipine and valsartan. There were major drug interactions in potential patients. There were also allegations of drug side effects in patients. Therefore, it is necessary to record more complete the drug usage and clinical data of the patients to make it easier in monitoring the effects of antihypertensive drugs administration on patients ’blood pressure and drug related problems.