Utilization Of Antihypertensive Medications Research Articles

Antihypertensive Medication Use Trajectories After Bariatric Surgery: A Matched Cohort Study.

Metabolic and bariatric surgery (MBS) is the most effective and durable treatment for obesity. We aimed to compare the trajectories of antihypertensive medication (AHM) use among obese individuals treated and not treated with MBS. Adults with a body mass index of ≥35 kg/m2 were identified in the Merative (US employer-based claims database). Individuals treated with versus without MBS were matched 1:1 using baseline demographic and clinical characteristics as well as AHM utilization. Monthly AHM use was examined in the 3 years after the index date using generalized estimating equations. Subanalyses investigated rates of AHM discontinuation, AHM initiation, and apparent treatment-resistant hypertension. The primary cohort included 43 206 adults who underwent MBS matched with 43 206 who did not. Compared with no MBS, those treated with MBS had sustained, markedly lower rates of AHM use (31% versus 15% at 12 months; 32% versus 17% at 36 months). Among patients on AHM at baseline, 42% of patients treated with MBS versus 7% treated medically discontinued AHM use (P<0.01). The risk of apparent treatment-resistant hypertension was 3.41× higher (95% CI, 2.91-4.01; P<0.01) 2 years after the index date in patients who did not undergo MBS. Among those without hypertension treated with MBS versus no MBS, 7% versus 21% required AHM at 2 years. MBS is associated with lower rates of AHM use, higher rates of AHM discontinuation, and lower rates of AHM initiation among patients not taking AHM. These findings suggest that MBS is both an effective treatment and a preventative measure for hypertension.

Natural resources can help reducing cardiovascular risk: randomized controlled study

Cardiovascular diseases are the leading cause of death globally accounting for 32 % of all global deaths. Addressing modifiable risk factors, including hypertension and stress, remains paramount in the prevention of CVD. This study aimed to assess the impact of the balneotherapy on blood pressure, heart rate, electrocardiogram parameters, utilization of antihypertensive medications, and stress levels. Methodology. Multicenter randomized controlled single-blind parallel group trial was made in 6 Lithuania resort centers. 373 participants with the stress level &gt; 3 (10, VAS) randomly divided into 6 groups in two clusters for receiving a 6- or 11-day complex treatment using natural resources – mineral waters, peloids, salt, nature therapy; follow-up period was 6 months. The BP, HR, ECG, stress level and other parameters were analyzed in 131 participants who passed a full course of investigation. Results. The significant reduction of systolic blood pressure after treatment (7.8 mmHg) and during 6 months (7.3 mmHg) together with diastolic 5.5 after 6 month and heart rate (4 b/min) was achieved in 11-day ambulatory balneotherapy group. Increase in the activity of the parasympathetic nervous system was observed, which is reflected by an increase in the duration of the ECG indicators. The stress level decreased by up to 43%, and stress management improved by up to 41% following inpatient treatment. Conclusion. Therapy using natural resources could stand for additional cardiovascular disease prevention and management method in integrative therapy.

Korea Hypertension Fact Sheet 2023: analysis of nationwide population-based data with a particular focus on hypertension in special populations

BackgroundThe Korea Hypertension Fact Sheet 2023, presented by the Korean Society of Hypertension, offers an overview of the prevalence and management of hypertension, along with recent trends.MethodsData for the Fact Sheet were derived from the Korea National Health and Nutrition Examination Survey spanning 1998 to 2021, and the National Health Insurance Big Data from 2002 to 2021.ResultsAs of 2021, hypertension affected 28.0% of Korean adults aged 20 and older, totaling approximately 12.3 million individuals, with 5.3 million (43.5%) aged 65 or older. Among those with hypertension, awareness stood at 74.1%, treatment rates at 70.3%, and control rates at 56.0%. Over the years, the number of hypertension diagnoses increased from 3.0 million in 2002 to 11.1 million in 2021. During the same period, the utilization of antihypertensive medications rose from 2.5 million to 10.5 million, with treatment adherence also improving from 0.6 million to 7.8 million individuals. In 2021, the predominant antihypertensive drug class was angiotensin receptor blockers (75.1%), followed by calcium channel blockers (61.7%), diuretics (23.4%), and beta blockers (15.3%). Notably, 60.2% of all antihypertensive prescriptions involved combination therapy with at least two classes of antihypertensive medication. There was a positive trend towards stricter blood pressure control targets (systolic/diastolic blood pressure < 130/80 mmHg) among elderly hypertensive patients, as well as those with diabetes, obesity, and high-risk hypertension. However, this trend declined in individuals aged 80 years or older and those with chronic kidney disease in recent years.ConclusionIn Korea, hypertension management is making strides, yet the total number of hypertensive individuals is rising. Effectively addressing the growing population of elderly hypertensive patients and the persistently low treatment rates among younger individuals with hypertension is a critical challenge. Additionally, developing more efficient and customized policies for blood pressure control and cardiovascular disease prevention is imperative.

S-24-5: REAL WORLD DATA IN HYPERTENSION: DATA FROM JAPAN MEDICAL ASSOCIATION DATABASE OF CLINICAL MEDICINE (J-DOME) STUDY IN KANAGAWA

Despite the ease of access for the diagnosis of hypertension and the progression of antihypertensive medications, the consultation for hypertension or the control of blood pressure (BP) is not sufficient, and hypertension remains the major cause of death due to cerebrovascular and cardiovascular diseases. The Japan Medical Association Database of Clinical Medicine (J-DOME) was established in 2018 with the aim of advancing the level of medical care for lifestyle-related diseases (diabetes and hypertension). To compare the results of previous studies and clarify the current problems, Kanagawa Physicians Associations collaborated with J-DOME to conduct the Kanagawa hypertension study 2021 featuring with J-DOME. We compared three studies: the 2011 study (n = 826); the 2014 study (n = 1098); and the 2021 study featuring with J-DOME (n = 830). The BP values at office (mmHg) were 132.9 ± 13.2/75.8 ± 9.3 in 2011, 133.1 ± 14.6/77.2 ± 10.7 in 2014, and 136.5 ± 17.4/76.9 ± 11.6 in 2021 study. Significantly high systolic and diastolic BP were observed in the 2021 study (p &lt; 0.001) and the 2014 study (p = 0.02). The BP values at home (mmHg) were 128.6 ± 10.6/75.5 ± 8.7 in 2011, 129.4 ± 10.2/76.2 ± 8.9 in 2014, 128.0 ± 8.1/76.6 ± 8.3 in 2021 study. A significantly higher systolic BP was observed in the 2014 study (p = 0.03). Among patients whose target BP was &lt; 140/90 mmHg at the office and &lt; 135/85 mmHg at home, the achievement rates (at office/at home) were 72.5% and 75.8% in the 2011 study; 66.0%/68.5% in the 2014 study; and 46.7%/83.3% in the 2021 study. In contrast, among patients whose target BP was &lt; 130/85 mmHg at office and &lt; 125/75 mmHg at home, the achievement rates (at office/at home) were 31.6%/19.7% in 2011, 32.1%/16.9% in 2014, and 30.4%/19.1% in the 2021 study. Lower utilization of Ca-channel blockers, ARBs, alpha-blockers, and diuretics was observed in the 2021 study (all p &lt; 0.001). Because JSH recommends that BP at home is given more importance than BP at the office, the improvement in the achievement of target BP by 135/85 mmHg at home is acceptable. However, efforts should be focused on the management of patients requiring strict BP control who showed extremely low achievement rates and did not show any improvement over the last decade. Furthermore, the low frequency of utilization of antihypertensive medications, despite the large number of diabetes patients, is also a major issue that general practitioners should address as soon as possible.

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;

Clinical Characteristics and Predictors of All-Cause Mortality in Patients with Hypertensive Urgency at an Emergency Department.

Hypertensive urgency is characterized by an acute increase in blood pressure without acute target organ damage, which is considered to be managed with close outpatient follow-up. However, limited data are available on the prognosis of these cases in emergency departments. We investigated the characteristics and predictors of all-cause mortality in Korean emergency patients with hypertensive urgency. This cross-sectional study included patients aged ≥18 years who visited an emergency tertiary referral center between January 2016 and December 2019 for hypertensive urgency, which was defined as a systolic blood pressure of ≥180 mmHg and a diastolic blood pressure of ≥110 mmHg, or both, without acute target organ damage. The 1 and 3 year all-cause mortality rates were 6.8% and 12.1%, respectively. The incidence of emergency department revisits and readmission after 3 months and 1 year was significantly higher in non-survivors than in survivors. In a multivariate analysis, age ≥ 60 years (hazard ratio (HR), 16.66; 95% CI, 6.20–44.80; p < 0.001), male sex (HR, 1.54; 95% CI, 1.22–1.94; p < 0.001), history of chronic kidney disease (HR, 2.18; 95% CI, 1.53–3.09; p < 0.001), and proteinuria (HR, 1.94; 95% CI, 1.53–2.48; p < 0.001) were independent predictors of 3 year all-cause mortality. The all-cause mortality rate of hypertensive urgency remains high despite the increased utilization of antihypertensive medications. Old age, male sex, history of chronic kidney disease, and proteinuria were poor prognostic factors for all-cause mortality in patients with hypertensive urgency.

Phenotyping the Association between Nocturia and Hypertension: A Systematic Review and Meta-Analysis.

The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the clinical urology setting. We synthesized current evidence on the relationship between nocturia and hypertension as a function of nocturia severity, age, gender, race, body mass index and diuretic use. We searched PubMed®, EMBASE® and Cochrane databases for studies published up to May 2020. Random effects meta-analyses were performed to identify pooled odds ratios for nocturia given the presence of hypertension. Meta-regression and subgroup analyses were performed to identify differences across study samples. Of 1,193 identified studies, 25 met the criteria for inclusion. The overall pooled OR for the association of nocturia with hypertension was 1.25 (95% CI 1.21-1.28, p <0.001). Pooled estimates were 1.20 (1.16-1.25, p <0.001) and 1.30 (1.25-1.36, p <0.001) using a 1-void and 2-void cutoff for nocturia, respectively (p <0.001 between cutoffs). The association was more robust in patient-based (1.74 [1.54-1.98], p <0.001) vs community-based (1.24 [1.24-1.29], p <0.001) study samples (p <0.001). The association was stronger in females compared to males (1.45 [1.32-1.58] vs 1.28 [1.22-1.35], p <0.001), and Black (1.56 [1.25-1.94]) and Asian (1.28 [1.23-1.33]) vs White subgroups (1.16 [1.08-1.24]; p <0.05 for both). No effect was observed for age or body mass index. Evidence on diuretics was limited. Hypertension is associated with a 1.2-fold to 1.3-fold higher risk of nocturia. This association is more robust at a higher nocturia cutoff, in patient-based study samples, among females and in Black and Asian patients, but unrelated to age or body mass index.

Use of Antihypertensive Medications in Left Ventricular Assist Device Patients Who Undergo Sleeve Gastrectomy

The use of antihypertensive medications has been shown to significantly decrease in most morbidly obese patients who undergo sleeve gastrectomy (SG) surgery, with 58% of patients having complete resolution of their hypertension. It is unknown if this same effect is seen in morbidly obese patients with left ventricular assist devices (LVAD) who undergo SG. This is a single center retrospective study of morbidly obese patients with stage D heart failure who underwent LVAD surgery with concomitant or subsequent SG and remained on LVAD support for at least 6 months. Baseline demographics, mean blood pressure (MAP) readings, medications, and compliance were collected by chart review from the first clinic visit following SG, at 6 months, and at 12 months. A total of 28 (57.1% Male, mean age 47.5 ±12 years) patients underwent LVAD with SG between November 2013 and June 2018. Twenty patients had concomitant SG during LVAD implantation and seven patients had SG between 5 and 20 months following LVAD implantation. One patient had SG 6 months prior to LVAD implantation. Prior to SG, average body mass index (BMI) was 43 kg/m2. At initial clinic visit, mean MAP was 88.54mmHg (±15.9mmHg). Only 42.9% of patients were on at least one antihypertensive agent, 14.3% were on two agents concomitantly. At 6 months, mean BMI was 34.2% kg/m2, mean MAP was 82.8mmHg (±12.34mmHg) with 39.3% on at least one antihypertensive agent, 21.4% were on two agents. At 12-months, mean BMI was 32.7 kg/m2, mean MAP was 89.1mmHg (±14.13mmHg), with 37.5% were on at least one antihypertensive agent, 29.2% were on two or more agents. Unlike non-LVAD patients undergoing SG, it appears that there is no statistically or clinically significant decline in utilization of antihypertensive medications in LVAD patients despite a reduction in BMI. This could be related to improved nutritional status despite weight loss in chronically ill stage D heart failure patients along with LVAD-patient related interaction.

Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial).

Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

Abstract P378: Current Progress of Antihypertensive Medication Use According to Healthy People 2020 Goals Among Adults With Hypertension- the National Health Interview Survey 2014-2015

Background: Hypertension is a major risk factor for heart disease and stroke; yet only half of those with hypertension have it under control. One of the Healthy People 2020 goals is to increase the proportion of adults with hypertension who are taking antihypertensive medications to lower their blood pressure from a baseline of 63.2% to a target of 69.5% by 2020. The objective of this study was to examine progress towards meeting this national objective and to assess disparities mid-decade. Methods: Adult participants (≥18 years) with self-reported hypertension from the National Health Interview Survey in 2014 and 2015 were included in this study. Current antihypertensive medication use was assessed and age-standardized for analysis. Multivariable logistic regression models were used to determine the odds ratio of antihypertensive medication use, adjusting for age, sex, race/ethnicity, education and health care access status. Results: Among the 21,050 (26.7%) adults with self-reported hypertension, 69.2% reported current antihypertensive medication use and disparities were noted among subgroups. Adults with estimates of antihypertensive medication use that fell below the Healthy People 2020 goal (69.5%) included women, non-Hispanic whites, Hispanics, and those with access health care barriers (Table). Conclusion: To control hypertension, most patients require antihypertensive medications to achieve control. Understanding disparities in antihypertensive medication utilization is needed for all population to achieve Healthy People 2020 targets by the end of the decade.

Hypertension management in the oldest old: Findings from a large long-term care facility.

The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population.

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN).

BackgroundAntihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women.Methods and ResultsParticipants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42–52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow‐up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95% CI, 2.24–3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95% CI, 1.93–2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95% CI, 1.55–2.45) compared with whites. Use of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β‐blocker usage did not decrease over time.ConclusionsAmong this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.

A review on prescribing patterns of antihypertensive drugs.

Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.

Can Walmart make us healthier? Prescription drug prices and health care utilization

This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart's $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart's program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent.

Trends in the utilization of antihypertensive medications among Palestine refugees in Jordan, 2008-2012

ObjectivesThe purpose of this study is to describe trends in the utilization of antihypertensive medications, overall and by type of medication, specifically thiazide diuretics, as well as uncontrolled hypertension, in the Palestine refugee population in Jordan between 2008 and 2012.MethodsWe analyzed aggregate procurement data on antihypertensive medications derived from the United Nations Relief and Works Agency (UNRWA) pharmacy records between 2008 and 2012. Antihypertensive medications were aggregated and utilization was calculated overall and for specific types of antihypertensive medications (e.g. β-blockers, diuretics). We used the WHO (World Health Organization) defined daily dose (DDD) methodology, often used to evaluate drug utilization patterns using aggregate data, to calculate utilization defined as DDDs per 100 persons with hypertension. In addition, UNRWA medical records were used to measure the prevalence of uncontrolled hypertension in the primary care setting. Uncontrolled hypertension was defined as a systolic/diastolic blood pressure ≥140/90 in at least 2 out of 3 readings, one of which is the most recent reading, during the year for a patient diagnosed with hypertension.ResultsOverall, total utilization of antihypertensive medications has not changed between 2008 and 2012; hypertensive patients persistently used at least 2 antihypertensive medications daily (range 200–280 DDDs/100 patients with hypertension) during this five-year period. However, there is significant variation in utilization patterns by type of antihypertensive medication. While Angiotensin Converting Enzyme Inhibitors (ACE-I) were persistently the most commonly used antihypertensive medication, there utilization significantly (P < 0.05) declined by 26%. However, there was a statistically significant increase of 124% in the utilization of thiazide diuretics. Further, the prevalence of uncontrolled hypertension has also declined at a rate of 3% annually between 2008 and 2012.ConclusionOur findings indicate that the STGs for hypertension management implemented in 2009 as part of UNRWA's essential drug program have increased the utilization of thiazide diuretics, and potentially contributed to improvements in hypertension control. This study also demonstrates that feasibility of drug utilization studies in monitoring and evaluating trends in the use of essential medications in low-resource settings.

English

This study aimed to evaluate drug utilization of anti-hypertensive medications in a tertiary care teaching hospital. In this study, a cross sectional study was conducted in hypertensive who visited General Medicine department in a tertiary care teaching hospital, during the period of August, 2013 to August, 2014. 1407 new prescriptions were analyzed according IP/OP numbers of rational drug utilization by using WHO Core drug use indicator and WHO ATC/DDD metric systems. A total of 10,638 drugs were prescribed. Of this, (20.4%) antihypertensive, (45.21%) angiotensin converting enzyme (ACE) inhibitors, 24.0% beta blockers, 17.7% calcium channel blockers, 11.4% diuretics, 1.5% angiotensin II receptor antagonist, 7.56 ± 2.76 mean number of drugs prescribed/prescription, 34.9% free drugs were prescribed from Tamil Nadu Standard Treatment Guidelines (TNSTG), 65.05% were prescribed from Rajah Muthaih Medical College Hospital Drug List (RMMCH). 14.9% antibiotics, 46.76% Injections, mean 13.8 min consultation and mean 147.48 seconds dispensation, both conceived as good patient care, 89.1% drugs actually dispensed, 87.1% drugs adequately labeled, 38.3% subjects had adequate knowledge on frequency of taking medicines. A total (n=82) subjects were admitted in the internal ward and average length of hospital stay was found to be 10.33 ± 6.66 and overall antihypertensive drug consumption was found to be 122.07 DDD/100 Bed-days. The present study finding showed, ACE inhibitors were most frequently prescribed and amlodipine was highest consumed drug in the internal ward. Many of the prescriptions were observed rationally, even though further more improvement is needed in drug prescribing practices for hypertensive study population. Key words: Anatomic therapeutic chemical (ATC), core drug use indicators, defined daily dose (DDD), drug utilization, hypertension.

English

BACKGROUND: Drug utilization studies conducted at regular intervals help to guide the physician in prescribing drugs rationally. OBJECTIVE: The objective of the present study was to assess the drug utilization patterns of antihypertensive in geriatric and non-geriatric patients in a tertiary care government teaching hospital. METHODS: A prospective cross sectional study was conducted in a tertiary care government teaching hospital. Data was collected from patients who have been diagnosed with hypertension as per JNC-7 guidelines and patients receiving or prescribed with antihypertensive medications were included. Frequency and proportions of utilization of antihypertensive medications in geriatric and Non-geriatric patients were charted and figured. RESULTS: A total of 226 prescriptions were analyzed during the three month study period. The most common medication prescribed for hypertension in the study was ARBs 27.77%, 34.37% in Geriatric and Non-geriatric patients respectively. The ARBs prescribed pattern was followed by ACEIs and CCBs. The most frequently prescribed anti-hypertensive fixed dose combination therapy was ARB+D, ACEI+D followed by CCB+BB in both Geriatric and Non-geriatric groups. CONCLUSION: The present study showed that the prescription pattern of antihypertensive was based upon the duration, severity of illness and the associated co-morbidities, it does not depend on the age of the patients.

The COSEHC&amp;trade; Global Vascular Risk Management quality improvement program: first follow-up report

The Global Vascular Risk Management (GVRM) Study is a 5-year prospective observational study of 87,863 patients (61% females) with hypertension and associated cardiovascular risk factors began January 1, 2010. Data are gathered electronically and cardiovascular risk is evaluated using the Consortium for Southeastern Hypertension Control™ (COSEHC™)-11 risk score. Here, we report the results obtained at the completion of 33 months since study initiation. De-identified electronic medical records of enrolled patients were used to compare clinical indicators, antihypertensive medication usage, and COSEHC™ risk scores across sex and diabetic status subgroups. The results from each subgroup, assessed at baseline and at regular follow-up periods, are reported since the project initiation. Inference testing was performed to look for statistically significant differences between goal attainments rates between sexes. At-goal rates for systolic blood pressure (SBP) were improved during the 33 months of the study, with females achieving higher goal rates when compared to males. On the other hand, at-goal control rates for total and low-density lipoprotein (LDL) cholesterol (chol) were better in males compared to females. Diabetic patients had lower at-goal rates for SBP and triglycerides but higher rates for LDL-chol. The LDL-chol at-goal rates were higher for males, while high-density lipoprotein (HDL)-chol rates were higher for females. Utilization of antihypertensive medications was similar during and after the baseline period for both men and women. Patients taking two or more antihypertensive medications had higher mean COSEHC™-11 scores compared to those on monotherapy. With treatment, hypertensive patients can reach SBP and cholesterol goals; however, population-wide improvement in treatment goal adherence continues to be a challenge for physicians. The COSEHC™ GVRM Study shows, however, that continuous monitoring and feedback to physicians of accurate longitudinal data is an effective tool in achieving better control rates of cardiovascular risk factors.

Incidence and treatment of hypertension in the neonatal intensive care unit

The incidence and risk factors for hypertension in the neonatal intensive care unit (NICU) is inadequately defined, and the current utilization of antihypertensive medications in this specialized environment is not known. We evaluated the incidence of hypertension, associated risk factors, and utilization of antihypertensive drugs in the NICU using a large, geographically diverse pediatric database. A total of 123,847 NICU encounters were identified in the database. After exclusion of the 44,861 neonates with congenital cardiac disorders, 764 (1%) were coded with the diagnosis of hypertension. On multivariate analysis, the risk for hypertension was greatest in those neonates with a high All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness assessment (OR = 35.8), extracorporeal membrane oxygenation (OR = 3.8), coexisting renal disorder (OR = 4.7), and renal failure (OR = 2.4). Of the 441 (57.7%) infants receiving antihypertensive medication, the median duration of exposure was 10 days, and 45% were exposed to more than one antihypertensive medication. Vasodilators were used in 64.2% of hypertensive neonates, followed by angiotensin-converting enzyme inhibitors (50.8%), calcium channel blockers (24%), and alpha- and beta-blockers (18.4%). Although hypertension occurs infrequently in the NICU, certain neonates are at increased risk for this condition. Hypertensive infants are frequently exposed to antihypertensive medications, often to several different agents during their NICU course of treatment.

National Utilization of Antihypertensive Medications From 2000 to 2006 in the Veterans Health Administration: Focus on Thiazide Diuretics

The authors sought to determine the prescribing practices of clinicians treating veterans with hypertension. A descriptive analysis was performed using a national pharmacy database of patients with a diagnosis of hypertension receiving antihypertensive medication in the fiscal years 2000 to 2006. Angiotensin-converting enzyme inhibitors were the most frequently prescribed antihypertensive class, with utilization increasing from 56.0% in fiscal year 2000 to 63.2% of patients in 2006. Utilization of thiazide-type diuretics increased from 31.9% of patients in fiscal year 2000 to 42.0% in 2006. When patient comorbidities were taken into consideration, 48.1% of patients defined as having uncomplicated hypertension had at least one prescription for a thiazide diuretic in fiscal year 2006. Utilization by monotherapy and combination therapy were also evaluated. The trends in utilization allowed for identification of areas in which a change in prescribing practices may improve blood pressure control and health outcomes in the Veterans Health Administration.