Antihypertensive Prescription Patterns Research Articles

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

BackgroundHypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN. MethodsWe studied VLWH with a diagnosis of HTN who received care in the Veterans Health Administration (VHA) from January 2018 to December 2019. We evaluated HTN treatment and blood pressure control across demographic variables, including race, and by medical comorbidities. Data were also compared among VHA facilities. Predictors of HTN treatment and control were assessed in 2-level hierarchical multivariate logistic regression models to estimate odds ratios (ORs). The VHA facility random-effects parameters from the hierarchical models were used to calculate the median odds ratios to characterize the variation across the different VHA facilities. ResultsA total of 17,468 VLWH with HTN (mean age 61 years, 97% male, 54% Black, 40% White) who received care within the VHA facilities in 2018-2019 were included. 73% were prescribed antihypertension medications with higher prescription rates among Black vs White patients (75% vs 71%) and higher prescription rates among patients with a history of cardiovascular disease, diabetes, and kidney disease (>80%), and those receiving antiretroviral therapy and with controlled HIV viral load (∼75%). Only 27% of VLWH with HTN had optimal BP control of systolic BP <130 mmHg and diastolic BP <80 mmHg, with a lower rate of control among Black vs White patients (24% v. 31%). In multivariate regression, Black patients had a higher likelihood of HTN medication prescription (OR 1.32, 95% CI: 1.22-1.42) but were less likely to have optimal BP control (OR 0.82; 0.76-0.88). Important positive correlates of antihypertensive prescription and optimal BP control included: number of outpatient visits in prior year, and histories of diabetes, coronary artery disease, and heart failure. There was about 10% variability in both antihypertensive prescription and BP control patterns between VHA facilities for patients with similar characteristics. There was increased inter-facility variation in antihypertensive prescription among those with a history of heart failure and those not receiving antiretroviral therapy. ConclusionIn a retrospective analysis of large VHA data, we found that VLWH with HTN have suboptimal antihypertensive medication prescription and BP control. Black VLWH had higher HTN medication prescription rates but lower optimal BP control.

Antihypertensive drug prescription patterns and their impact on blood pressure outcomes in a tertiary care teaching hospital

Background: The guidelines from the Joint National Committee (JNC-8) emphasize the importance of rapid blood pressure (BP) control to reduce morbidity and mortality. The success of hypertension treatment depends on various factors, with irrational prescription being strongly linked to poor BP control. This study aimed to evaluate the patterns of antihypertensive drug prescriptions among patients in a tertiary care teaching hospital. Methods: A hospital-based observational study was conducted in 2018, including all hypertensive patients on medication. Their prescription patterns were analyzed. Results: The study analyzed prescriptions from 240 hypertensive patients. The mean ages for male and female patients were 56.68±15.32 and 62.29±12.65 years, respectively. Physicians commonly prescribed monotherapy (34.60%) followed by two-drug (18.40%), three-drug (11.80%), and four-drug combinations (3.00%). The most frequent two-drug combination was ACE inhibitors + diuretics (4.40%), followed by angiotensin receptor blockers (ARBs) + diuretics (3.60%) and calcium channel blockers (CCBs) + ACE inhibitors (2.60%). Adherence to JNC 8 guidelines was 19.3% for pre-hypertension, 88.70% for stage 1 hypertension, and 73.29% for stage 2 hypertension. Conclusions: Monotherapies were the most commonly prescribed regimens. Twice-daily dosing and monthly appointments were associated with lower incidences of uncontrolled BP. However, complete adherence to standard guidelines was not observed in all cases, especially in patients with comorbid conditions.

To Study the Prescription Pattern of Antihypertensive Drugs in Teerthanker Mahaveer Hospital Moradabad (U.P.)

Objective of the study: To assess prescribing pattern of antihypertensive drugs use and adherence to various clinical guidelines in the Hospital. Materials and methods: A prospective observational study was carried out for a period of six months in the IPD and OPD tertiary care hospital. Prescriptions were analyzed during the study period. All the patients of age ≥ 20 (20-70 age) years with or without comorbidities, including males and females, who were diagnosed with hypertension as per JNC 8, ESH/ESC, NICE, STG, IHG, and receiving antihypertensive drugs were included. Discussion: The results of our study suggested that out of the total number of hypertensive patients (202) males were 54.45% witch females were 45.55%. Therefore, there was immensely need of proper awareness about the hypertension and its etiologies among the population especially of younger generation. In this scenario, clinical pharmacist could do a lot more for the patients and overall society because of their expertise in Pharmaceutical Care. Conclusion: Calcium channel blockers, Diuretics, ARB as monotherapy and ARB with CCB as combination therapy were the choices for the treatment of Hypertensive patients as a single drug and combination drug therapy. As per the JNC 8 &amp; ESC/ESH guidelines majority of the prescription patterns were achieved and found optimal at the study site.

Antihypertensive therapy during pregnancy: the prescription pattern in Italy.

Drug use during pregnancy should be evidence-based and favor the safest and most appropriate prescription. The Italian Medicines Agency (AIFA) coordinates a network focusing on monitoring medication use in pregnancy. Hypertensive disorders are common medical complication of pregnancy and antihypertensive therapy is prescribed to reduce the risk of adverse feto-maternal complications. The objective of this study is to highlight the prescription pattern of antihypertensive drugs before pregnancy, during pregnancy and in the postpartum period in Italy and to evaluate their use with a specific attention to the prescription pattern of drugs considered safe during pregnancy. A multi-database cross-sectional population study using a Common Data Model (CDM) was performed. We selected all women aged 15-49years living in eight Italian regions who gave birth in hospital between 1 April 2016 and 31 March 2018. In a cohort of 449.012 women, corresponding to 59% of Italian deliveries occurred in the study period, the prevalence of prescription of antihypertensive drugs in the pre-conceptional period was 1.2%, in pregnancy 2.0% and in the postpartum period 2.9%. Beta-blockers were the most prescribed drugs before pregnancy (0.28%-0.30%). Calcium channel blockers were the most prescribed drugs during pregnancy, with a prevalence of 0.23%, 0.33%, 0.75% in each trimester. Alfa-2-adrenergic receptor agonists were the second most prescribed during pregnancy with a prevalence of 0.16%, 0.26% and 0.55% in each trimester. The prescription of drugs contraindicated during pregnancy was below 0.5%. Only a small percentage of women switched from a contraindicated drug to a drug compatible with pregnancy. The analysis showed little variability between the different Italian regions. In general, the prescription of antihypertensive drugs in the Italian Mom-Network is coherent with the drugs compatible with pregnancy.

Trends of antihypertensive use in a tertiary care hospital in Nadia district of West Bengal, India

Background: Being a major non-communicable disease hypertension contributes significantly to disease burden and mortality. Poor control of blood pressure (BP) increases the chance of recurrent stroke and mortality. Although various guidelines have been published to inform practitioners about hypertension and its management, it is necessary to monitor to how much extent the guidelines are being followed. Aims and Objectives: The study aimed to observe antihypertensive medication prescription pattern among indoor patients in a tertiary medical college hospital and to know whether such trend of prescription is relevant and in conformity with the national and international guidelines. Materials and Methods: A prescription-based survey was conducted over 6 months among patients admitted to the medicine ward in a medical college hospital in Nadia district of West Bengal. Relevant data were collected and used for analysis. Results: A total of 500 prescriptions were evaluated. Two hundred and seventy-three patients were female (54.6%) and 227 patients were male (45.4%). About 56.2% of patients were in the senior age group with a higher contribution by the female subjects. Only 17% of patients had Grade 1 hypertension reflecting poor BP control among hypertensive patients. Combination drug was advised in more than half of cases (54.6%), whereas single drug was advised in 44.2% of cases. Amlodipine was the highest prescribing drug (66%) both as monotherapy and in combination followed by Lasix (54.6%), labetalol (31.6%), and telmisartan (11.4%). The thiazide group of drugs was used only in 1% of cases. Conclusion: Overall, the management guidelines for hypertension were adhered in the prescriptions. The underutilization of thiazide-type diuretics remains an area of concern and needs necessary action. The public health delivery system may need to take appropriate measures to make people aware of BP control.

Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford Kidney Study.

Hypertension is commonly observed in patients living with chronic kidney disease (CKD). Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD. There remains variability in antihypertensive treatment practices. To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients. The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002. All patients are followed up annually, and their medical records including the list of medications are updated until they reach study endpoints [starting on renal replacement therapy or reaching estimated glomerular filtration rate (eGFR) expressed as mL/min/1.73 m2 ≤ 10 mL/min/1.73 m2, or the last follow-up date, or data lock on December 31, 2021, or death]. Data on antihypertensive prescription practices in correspondence to baseline eGFR, urine albumin-creatinine ratio, primary CKD aetiology, and cardiovascular disease were evaluated. Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis. Kaplan-Meier analysis demonstrated differences in survival probabilities. Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included. The median age was 65 years. A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages (53% of eGFR ≤ 15 mL/min/1.73 m2 vs 26% of eGFR ≥ 60 mL/min/1.73 m2, P < 0.001). An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased (category A3: 62% vs category A1: 40%, P < 0.001), with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers. The prescription of three or more antihypertensive agents was associated with all-cause mortality, independent of blood pressure control (hazard ratio: 1.15; 95% confidence interval: 1.04-1.27, P = 0.006). Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed (log-rank, P < 0.001). Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm. Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents. Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.

Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery.

Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.

Renin‐angiotensin-aldosterone system inhibitors and mortality risk in elderly patients with atrial fibrillation. Insights from the nationwide START registry

BackgroundArterial hypertension is the most common cardiovascular comorbidity in atrial fibrillation (AF). Few studies investigated management strategies of hypertension in AF. Materials and methodsWe included 5769 AF patients on oral anticoagulants from the nationwide ongoing Italian START registry. We investigated the prescription of antihypertensive drugs and mortality risk. Subgroup analyses according to sex and major cardiovascular comorbidities were performed. ResultsMean age was 80.8 years, 46.1% were women; 80.3% of patients were hypertensive. Furosemide (30.1%) was the most frequent diuretic followed by hydrochlorothiazide (15.4%) and potassium canrenoate (7.9%). 61.1% received β-blockers: 34.2% bisoprolol, 6.2% atenolol. Additionally, 36.9% were on angiotensin converting enzyme inhibitors (ACE-I): ramipril (20.9%), enalapril (5.3%) and perindopril (2.8%); 31.7% were on angiotensin receptors blockers (ARBs): valsartan (7.6%) and irbesartan (6.4%). Amlodipine and lercanidipine were prescribed in 14.0% and 2.3%, respectively. ACE-I (p < 0.001), α-blockers (p = 0.020) and Dihydropyridines calcium channel blockers (p = 0.004) were more common in men, while ARBs (p = 0.008), thiazide diuretics (p < 0.001) and β-blockers (p < 0.001) in women.During 22.61 ± 17.1 months, 512 patients died. Multivariable Cox regression analysis showed that ACE-I (Hazard ratio [HR] 0.758, 95% Confidence Interval [95%CI] 0.612–0.940, p = 0.012) and ARBs (HR 0.623, 95%CI 0.487–0.796, p < 0.001) inversely associated with mortality. ACE-I/ARBs inversely associated with mortality in both sexes and in patients with diabetes. This associastion was evident for ACE-I in patients with previous cardiovascular disease, and for ARBs in HF. ConclusionA lower mortality risk was found in AF patients on ACE-I/ARBs. Different prescription patterns of antihypertensive drugs between men and women do exist.

A prospective observational study of prescription pattern of antihypertensive drugs in general medicine outpatient department of associated hospital RUHS CMS, Jaipur

Background: The increasing prevalence of hypertension is attributed to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress. The aim of study is the prescribing pattern and the consumption of antihypertensive drugs in isolated hypertensive patients and in hypertensive patients with different co-existing morbidities. Methods: The present study is a Prospective observational study. The study was conducted at Medicine Department of associated hospital of RUHS College of Medical Sciences, Jaipur. Results: A total of 965 patients having hypertension were analyzed, in that 556 patients were male and 409 patients were female. In hypertension patients, angiotensin receptor blockers ARB, diuretics and β- blockers (29.90%) were mostly used classes in three drug therapy. Whereas telmisartan, hydrochlorothiazide and metoprolol (35.05%) were mostly prescribed. Drugs. In hypertension patients, angiotensin receptor blockers ARB, diuretics, β- blockers and calcium channel blockers (56.67%) and calcium channel blockers, angiotensin converting enzyme inhibitors, β-blockers and diuretics (43.33%) were used classes in four drug therapy. Whereas Telmisartan, Hydrochlorothiazide, Nebivolol and Amlodipine (62.5%) were mostly prescribed drugs. Hypertensive Patients with Comorbidity were found in higher prevalence with 276 hypertensive patients (28.60%) along with Diabetes Mellitus most commonly found and 389 hypertensive patients (40.31%) were found to be with No Comorbidity. Conclusions: Present results reveal that antihypertensive medication adherence to JNC-8 recommendations is suboptimal. Therefore, physicians should follow JNC-8 guidelines to improve the patients care because suboptimal adherence leads to adverse clinical outcomes. The present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with co-morbid conditions.

#5507 ANTIHYPERTENSIVE PRESCRIBING PATTERNS IN CKD: FINDINGS FROM THE SALFORD KIDNEY STUDY

Abstract Background and Aims Hypertension is the second leading cause of chronic kidney disease (CKD) following diabetes and occurs in most patients with CKD. Finding an optimal treatment regime for hypertension remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD, and hypertensive CKD patients may require treatment with multiple antihypertensive drugs. Database studies and practice guidelines have continued to demonstrate international variability in antihypertensive treatment practices. We analysed data from the Salford Kidney Study (SKS) database in relation to antihypertensive prescribing patterns amongst study patients. Method The SKS is an ongoing prospective study recruiting patients with CKD since the year 2002. Data including patient demographics, comorbidities, physical parameters, concurrent medications, and biochemical results are collected at baseline (study enrolment). All patients are followed up annually until they reach their endpoints [reaching end-stage kidney disease (ESKD), death, or discharge from follow-up] individually, with updates in their medical records including a list of medications. We have used Cox regression analysis and Kaplan Meier charts to investigate the associations between Renin-Angiotensin-Aldosterone System inhibitor (RAASi) use and the number of antihypertensive agents (binary groups of ≤3 or &amp;gt;3), and clinical outcomes (ESKD and all-cause mortality). Results A total of 3230 patients recruited between October 2002 and December 2019 were included in this analysis. At baseline, the median age of the cohort was 67 years with a predominance of males (62%) and those of white ethnicity (96%). 90% had a history of hypertension and 32% were diabetic. The median blood pressure was 138/75 mmHg. Previous myocardial infarction was recorded in 15%, congestive cardiac failure in 17% and cerebrovascular disease in 7.7% of the patients. The median estimated glomerular filtration rate (eGFR) was 30 ml/min/1.73 m2 and the median urine protein creatinine ratio (uPCR) was 33 mg/mmol. RAASi agents (ACEi &amp; ARB) (56%) were the most common antihypertensive medications to be prescribed, followed by diuretics (50%), calcium channel blockers (45%), and beta blockers (34%). The proportion of patients prescribed RAASi was associated with greater proteinuria (43 vs 33%, p&amp;lt;0.001). CKD patients with preexisting cardiovascular comorbidities were more likely to be prescribed beta blockers (44 vs 27%, p&amp;lt;0.001), diuretics (58 vs 39%, p&amp;lt;0.001) and mineralocorticoid antagonists (6.4 vs 1.85%, p&amp;lt;0.001). An increasing number of CKD patients were being prescribed ARBs over 24-month follow-up (34 vs 28%, p = 0.02). In a multivariable Cox-regression analysis, RAASi intake was not associated with reaching ESKD (HR 0.91; p = 0.49) but was associated with a significant survival benefit (HR 0.84; p = 0.001) (Figure 1). Use of a higher number of antihypertensive agents (i.e. &amp;gt;3) was associated with both greater mortality (HR 1.28; p = 0.02) and worse dialysis-free survival (HR 1.46; p = 0.007) (Figure 2). Conclusion Antihypertensive prescribing patterns in the SKS were consistent with current guidelines in the U.K. (e.g. NICE guidance 2022), with RAASi being predominantly prescribed as the first-line antihypertensive agent. An overall survival benefit was noted with RAASi use, although there was no signal for reducing progression towards ESRD. Outcomes were poor in patients with resistant hypertension needing multiple antihypertensive agents. Considering existing variations between the U.K. and other international guidelines regarding antihypertensive treatment in CKD, continued research is indicated to bridge the gaps between these recommendations and optimise patient outcomes.

Study to Analyse Prescription Pattern of Antihypertensive Drugs Used in Preeclampsia Patients at a Secondary Care Hospital: A Prospective Observational Study

Study to Analyse Prescription Pattern of Antihypertensive Drugs Used in Preeclampsia Patients at a Secondary Care Hospital: A Prospective Observational Study

Analysis of prescription status of antihypertensive drugs in Chinese patients with hypertension based on real-world study

Background Globally, the prevalence of hypertension and the accompanying burden of cardiovascular disease are increasing. Through drug utilization research, we can understand the prescription status of hypertension patients and promote rational drug use. The purpose of this retrospective study was to describe the current prescription pattern of antihypertensive drugs in Chinese patients and determine the compliance level of treatment guidelines. Materials and methods Around 11.1 million patients who received a prescription for antihypertensive therapy between January 2021 to December 2021 were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. Results The mean age of hypertensive patients was 54.75 ± 12.98 years. About 6.7 million (60.30%) were males. About 46.07% of patients had comorbidities. The most common classes of antihypertensive medications used were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). Around 78.33% of participants were on monotherapy. Diuretics + ARBs and Diuretics + CCBs + ARBs were the most commonly prescribed pattern in two-drug combination therapy and three-drug combination therapy, respectively. Conclusions CCBs and ARBs were the two most frequently prescribed for patients with hypertension. The prescription pattern of antihypertensive medications in the study largely complied with recommended Chinese hypertension guidelines. Key messages Cardiovascular disease is the most common complication of hypertension. Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) are the two most commonly used drugs for hypertension patients in China. The proportion of combination prescription pattern in Chinese hypertensive patients is low.

Prescribing patterns and pharmacoeconomic analysis of antihypertensive drugs in South Indian population: A cross-sectional study.

Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population.

Study to analyse prescription pattern of antihypertensive drugs used in preeclampsia patients at a secondary care hospital: A Prospective observational study

Study to analyse prescription pattern of antihypertensive drugs used in preeclampsia patients at a secondary care hospital: A Prospective observational study

Study to analyse prescription pattern of antihypertensive drugs used in preeclampsia patients at a secondary care hospital: A Prospective observational study

Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Once the hypertension is diagnosed starting with antihypertensive therapy help to manage the outcomes of pregnancy, for both mother and baby. The main objective of the study is to assess prescribing patterns of antihypertensive drugs in pregnant women. It was a prospective observational study that was conducted for 4 months from November 2021 to February 2022. A total of 120 prescriptions were analyzed. Through the current study, we could assess the utilization of antihypertensive drugs in pregnant women. The study reveals that most of the patients having PIH were from Primi gravida in the age group 25-28 years old. The study also shows that Labetalol an alpha-beta blocker is mostly prescribed as monotherapy followed by Nifedipine a calcium channel blocker, or a combination of Labetalol with Nifedipine. Also according to the study, 12% of patients showed co-morbidities and the other 88% were without co-morbidities. Other than antihypertensive prescribed to maximum patients were a combination of several supplements that are protein powders, iron-calcium supplements (Protex powder, Anaport powder, LG-9 sachet, bio folate, calcium supplements, Hbcare, cc250, RG-9 sachet). The current study assessed that most of the patients showed mild to moderate preeclampsia that is blood pressure between 140-160 mmHg. It will help the prescriber to pay more attention to the outcomes of B.P. during pregnancy. If PIH can be treated rationally the complication of pregnancy that affect the mother and baby can be overcome and there would be a significant reduction in maternal and perinatal morbidity and mortality.

DRUG USAGE PATTERN OF ANTIHYPERTENSIVES IN DIABETIC PATIENTS – A CROSS-SECTIONAL OPD-BASED STUDY IN A TERTIARY CARE SET-UP

Objective: The objective of this study was to observe the pattern of utilization of different groups of antihypertensive drugs in patients with diabetes in a tertiary care hospital and correlate the data obtained from the study. Methods: It was an institution-based cross-sectional study; the present study was carried out at M.G.M. Medical College and L.S.K. Hospital in Kishanganj, Bihar, in the Department of Pharmacology. This study included 520 diabetes mellitus patients with hypertensive disorders who presented to the Department of Medicine at M.G.M. Medical College and L.S.K. Hospital, Kishanganj, during the study period (June 2021–May 2022). Results: When we appeared at the prescribing patterns of antidiabetic drugs, we found that metformin was the most common (80%), followed by sulfonylureas (65%), DDP4 inhibitors (56.7%), and alpha-glucosidase inhibitors (5%). An evaluation of the pattern of hypertensive drugs prescribed to study subjects revealed that monotherapy was the preferred option (77.1%) over combination therapy (22.9%). Telmisartan (32.4%) is the most common drug used in monotherapy among the study subjects included in the present study, followed by Amlodipine (27.4%) and Metoprolol (14.5%), Bisoprolol (14.5%), and Clinidipine (11.2%), respectively. Conclusion: The evaluation of all medications prescribed was reasonable and in compliance with JNC-8 treatment guidelines. Further, research is needed to qualify the rationale for drug choice based on demographics, economic status, comorbidities, and complications to provide additional insight into antihypertensive drug prescribing patterns in people with diabetes so the results can be translated for broader and more real benefits can become a medical community.

A Review on Hypertensive Drug Prescription

Hypertension is considered to be the vital reason of mobidity and mortality in the society. It is an important risk aspect for cerebro-vascular, cardiovascular, and renal problems. A number of national and international guidelines for the management of hypertension have been published. The increasing occurrence of hypertension and the frequently escalating expenditure of its treatment control the prescribing patterns amongst physicians and compliance to the treatment by the patients. from the time when several years ago, diuretics were calculated as the first-line drugs for management of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) advise both calcium channel blockers in addition to angiotensin converting enzyme inhibitors as first-line drugs, in adding up to diuretics. This assessment aims on the antihypertensive medication utilization, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in various settings. The antihypertensive medication prescribing pattern studies assist to observe, estimate and essential changes to the prescribing practice to get rational and cost-effective treatment. In addition, there should always be an updating of recommended guidelines and inventive drug formulations, and prescription monitoring evaluations help in rational use of antihypertensive drugs, which can be tailored to go with the patients' requirements, counting those in the emergent countries.&#x0D;

Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia.

To determine the impact of drug prescribing pattern, outpatient drug price of medicines, and level of adherence to evidence-based international guidelines on blood pressure (BP) control at selected hospitals in Southern Ethiopia. Hospital-based cross-sectional study was conducted. The data entry and analysis were done by using SPSS version 21.0. A mean age of participants was 55.87 ± 11.02years. The rate of BP control was 17.5% based on International Society of Hypertension (ISH) guidelines 2020. In about two-thirds of patients, 270 (66.5%) were taking combination therapy. Mean annual cost of drugs for hypertension was 11.39 ± 3.98 US dollar (USD). Treatment was affordable for only 91 (22.4%) of patients. There was considerable variation on prescriber's adherence to evidence-based guidelines. Body mass index (BMI) of 18-24.9kg/m2, adjusted odds ratio (AOR) = 3.63 (95% confidence interval (C.I), 1.169-11.251, p = 0.026), physically activity, AOR = 12.69 (95% C.I, 1.424-113.17, p = 0.023), presence of no comorbidity, AOR = 12.82 (95% C.I, 4.128-39.816, p = 0.000), and taking affordable antihypertensive regimen, AOR = 3.493 (95% C.I, 1.4242-9.826, p = 0.018), were positively associated BP control. The level of BP control, affordability of drugs for the management of hypertension and related comorbidities, and the prescriber's adherence to evidence-based guidelines were inadequate. Therefore, addressing factors associated with good BP control including affordability and clinician adherence to evidence-based guidelines by responsible stakeholders could improve BP control and reduce associated complications.

Study of Antihypertensive Use in Elderly Subjects with or Without Comorbid Conditions in A Tertiary Care Hospital

Hypertension is the commonest cardiovascular disorder, with the prevalence progressively increasing with age and elderly subjects are more prone for various hypertension-related complications. Presence of various co-morbid conditions influences the choice and dose of antihypertensive medications. Persistent adherence to the prescribed medications and lifestyle measures are very essential to reduce the morbidity and mortality, and to improve the QOL. The objective of the study is to determine the pattern of antihypertensive prescribing, to assess the medication compliance and Quality of life. 250 elderly hypertensive subjects of either gender were recruited in to the present study to assess the prescribing pattern of antihypertensives; details of drug therapy, therapeutic class, dose, route, frequency, duration of administration. The compliance was 8-item questionnaire as per Morisky Medication Adherence Scale and the Quality of life was assessed using MINICHAL Instrument, consisting of 17-item questionnaire. The most commonly prescribed antihypertensives were angiotensin receptor blockers (55%) and calcium channel blockers (55%) and, angiotensin receptor blocker + thiazide diuretic combination was the commonest dual antihypertensive therapy prescribed. 41.2% subjects had good level of medication compliance, 48.4% subjects had moderate level of compliance and 10.4 % subjects had poor level of compliance. The mean total scores of the HRQoL scale in the subjects with pre hypertension was 26.20±8.01, 25.66±9.38 in subjects with stage 1 HTN and 29.36±8.66 in subjects with stage 2 HTN. The most common antihypertensives were angiotensin receptor blockers and calcium channel blockers. The level of compliance was influenced by factors such as age, gender, co morbidities, severity of hypertension and number of medications. HRQoL of the study population was influenced by severity of hypertension.

Drug utilization study of anti-hypertensive drugs and prescription pattern adherence with joint national committee-8 guideline

Background: Hypertension is a major and serious non-communicable disease. It is also a major risk factor for cerebrovascular strokes, coronary artery thrombosis, and renal failure. The overall prevalence of hypertension in India is 29.8%. Joint national committee-8 guidelines on prevention, detection, evaluation, and treatment of high blood pressure highlight that aggressive blood pressure control is essential for the reduction of hypertension-associated morbidity and mortality.Methods: It was a cross-sectional, observational study. Prescriptions were collected from four pharmacy stores located in four different areas of Ahmedabad over a period of 2 months. These were analysed along with relevant co-morbidities and, the level of prescription pattern adherence was assessed as per JNC 8 guidelines. Appropriate statistical tests were applied for analyses of collected data.Results: A total of 321 prescriptions were collected. Out of them, 186(57.9%) were prescribed to male patients while 135 (42.1%) were for female patients. Mean systolic and diastolic blood pressure was found to be 152 mmHg and 91 mmHg respectively. The mean age of the patients was found to be 44.63 years. A total of 209 (65.1%), 91 (28.34%), 21 (6.54%) prescriptions had monotherapy, dual therapy, and polytherapy for treating hypertension respectively. Amlodipine (CCBs) was found to be the most commonly prescribed medicine as a monotherapy. The overall adherence rate was found to be 77.88%.Conclusions: The present study demonstrated that medical professionals are not completely adhering to standard guidelines while prescribing antihypertensive drugs. There is substantial scope for improvement, particularly the utilization of antihypertensive agents in patients of the pre-hypertension category, where non-pharmacological measures play an important role to treat the condition.