Antihypertensive Prescription Patterns Research Articles

Prescription pattern of antihypertensive drugs in a tertiary care teaching hospital

Background: Hypertension is a major health problem all over the world. It is not a disease in itself, but it is an important risk factor for cardiovascular mortality and morbidity. Objective: To evaluate the prescribing pattern of antihypertensive drugs in a tertiary care teaching hospital in Lucknow region. Materials and Methods: A cross-sectional study was carried out at the Outpatient Department in a tertiary care teaching hospital in Lucknow to access the prescription pattern of antihypertensive drugs during October 2015 to July 2016. Results: In the present study, 65.2% patients received monotherapy while 34.8% received combination therapy. In monotherapy, calcium channel blockers (CCBs) were most commonly prescribed, while angiotensin receptor blockers (ARBs) + diuretics were the most commonly prescribed combination therapy. Conclusion: In the present study, it was found that CCBs were the most commonly prescribed antihypertensive drug, followed by ARBs in monotherapy. Combination therapy was given according to associated risk factors and comorbid conditions.

Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study.

BackgroundIrrational prescription is strongly associated with poor control of hypertension. The present study aimed to evaluate antihypertensive drug prescription trends and to measure their impact on the level of blood pressure (BP) control in Gondar University Hospital, Gondar, Ethiopia.MethodsA hospital-based retrospective cross-sectional study was conducted from May 30 to June 30, 2016. All hypertensive patients on medication were included. A structured data abstraction form was prepared to gather the necessary information. The prescription patterns and BP level were measured retrospectively. A binary logistic regression was computed to determine the effect of different prescription patterns on BP control.ResultsA total of 596 hypertension patients were recruited for the study; of them, 561(94%) met the study criteria. The mean age of the respondents was 55.96±14.6 years. Females constituted 58.2% of the study population. Approximately fifty percent of the prescriptions were monotherapies. Twice-daily dosing was associated with lower risk of uncontrolled hypertension (crude odds ratio [COR] =0.51[0.15–0.73], adjusted odds ratio [AOR] =0.69[0.163–0.91]). Monthly appointment was linked with a nearly 90% reduced incidence of uncontrolled BP (COR =0.15[0.04–0.73], AOR =0.093[0.024–0.359]).ConclusionMonotherapies were the most frequently prescribed regimens. Twice-daily dosing and monthly appointments were associated with low incidence of uncontrolled BP. Clinicians should be vigilant in adjusting the frequency of dosing and should fix appointment date in consultation with their patients.

Pattern of Antihypertensive Treatment and Blood Pressure Control among Diabetic Outpatients in Addis Ababa, Ethiopia

Introduction: Hypertension and diabetes mellitus are currently the usual causes of morbidity and mortality among non-communicable diseases in both developed and developing countries. When occur together, the risk of death from cardiovascular diseases will double. Objective: This study was intended to assess the antihypertensive drug prescription pattern and blood pressure control among diabetic outpatients at St. Paul’s tertiary Hospital in Addis Ababa. Methods: A hospital based cross- sectional study design was used to review the medical registries of 484 diabetic-hypertensive outpatients seen between February 1st 2016 and July 30 2016. Results: The most commonly used antihypertensive drug classes in our patients were angiotensin converting enzyme inhibitor in 283 (58.5%), calcium channel blocker in 218 (45%) and beta blocker in 61 (12.8%) patients. The most commonly used monotherapy is angiotensin converting enzyme inhibitor in 110 (22.7%), calcium channel blocker in 89 (18.4%) and diuretic in 25 (5.2%). The currently recommended target systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg was achieved in 176 (36.4%) patients while the majority 308 (63.6%) did not attain the target blood pressure. Renal function was assessed in 484 (100%) patients, of whom 24 (5%) had renal impairment with an estimated glomerular filtration rate <60 ml/min/1.73 m2. Conclusion: The antihypertensive drug treatment pattern in our patients was in agreement with the current treatment guidelines. However, blood pressure control in the majority of patients is not adequate.

National Trends in Outpatient Antihypertensive Prescribing in People withDementia in the United States.

The objectives were to investigate national trends in outpatient antihypertensive prescribing in people with dementia in the United States between 2006 and 2012, and to investigate clinical and demographic factors associated with different antihypertensive prescribing patterns. This was an analysis of the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Outpatient visits by people aged ≥65 years with documented dementia were analyzed. Complex samples multivariate logistic regression was conducted to estimate temporal trends and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for factors associated with prescribing of antihypertensives, multiple antihypertensives and different antihypertensive classes. There was a statistically significant increase in the proportion of physician visits by older people with dementia with a documented diagnosis of hypertension from 49.3% (95% CI: 41.3% -57.4%) in 2006 to 55.7% (95% CI: 50.2% -61.2%) in 2012. There were non-significant increases in overall antihypertensive use and the use of multiple antihypertensive classes. Male sex was associated with any antihypertensive use (AOR 1.37, 95% CI 1.02-1.84) and multiple antihypertensive class use (AOR 1.52, 95% CI 1.14-2.04). Black race (AOR 2.04, 95% CI 1.12-3.71) and Midwest residence (AOR 2.03, 95% CI 1.46-2.82) were associated with multiple antihypertensive use. There was an increase in documented hypertension in physician visits by older people with dementia from 2006 to 2012, but minimal increases in overall antihypertensive use. Various demographic and clinical factors were associated with the prescribing of antihypertensives in people with dementia.

Evaluation Of Prescription Pattern And Medication Adherence Of Antihypertensive Drugs In Stage 1 Essential Hypertensive Patients At Rural Tertiary Care Teaching Hospital Of Central India.

Objectives- To study the prescription pattern of antihypertensive drugs and analyze the medication adherence to antihypertensive drugs at rural tertiary care teaching hospital. Materials and Methods - Prospective, observational, 12 weeks, questionnaire based study, conducted in rural tertiary care teaching hospital of central India. 214 antihypertensive prescriptions were analyzed by Morisky medication adherence scale. Statistical analysis was done by MS Excel and Graph pad prism 6.0. Results - 28.03% patients were not aware about the medicines taken, 29.90% patients were unacquainted about dose and route of administration whereas 32.71% patients were unfamiliar about frequency of administration of medicines. 53.27% patients were unaware about precautions to be taken while consuming medicines. 58.68% & 12.67% patients consumed amlodipine & atenolol respectively. In 16.43% patients, atenolol + amlodipine combination therapy was prescribed. Amongst 214 patients 12, 58 & 144 showed high, medium & low adherence respectively. No significant difference was found on gender basis at any level of adherence. Conclusion- In this study, physicians given preference to amlodipine than other antihypertensive drugs. However, thiazide is a first line drug in stage 1 hypertension, recommended by JNC VII guideline. This indicates that there is need of creating awareness about current management of hypertension to clinicians by organizing various workshops. We observed only 5.60% patients showed high adherence to antihypertensive therapy. Therefore educational strategies must be carried out for physicians focusing on causes for nonadherence to antihypertensive medications. Also raising patient trust in their physicians may improve patient motivation to prescribed medication.

MPS 14-04 Influence of habitual morning home blood pressure measurement on the prescription pattern of antihypertensive drugs

MPS 14-04 Influence of habitual morning home blood pressure measurement on the prescription pattern of antihypertensive drugs

Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study.

Hypertension is highly prevalent; in Mexico, the 2012 National Health and Nutrition Survey reported a prevalence of hypertension of 31.5% in the adult population. Pharmacological treatment is the commonest intervention and has been shown to reduce cardiovascular mortality and morbidity, and total mortality. Accordingly, the type and number of antihypertensives used and the outcome - in terms of blood pressure (BP) control - are important. Therefore, our purpose is to learn the pattern of antihypertensive drug prescription and explore the determinants of BP control in an urban population in Mexico. A retrospective cross-sectional drug utilization study was conducted. Medical records from a community health centre were searched to identify those corresponding to patients diagnosed with hypertension; information upon antihypertensives used and control of the disease was carefully retrieved. A logistic regression model was built to know the main determinants of BP control. A sample of 345 clinical records of interest was identified. Most patients received antihypertensives (86.4%); the leading medications used were angiotensin-converting enzyme inhibitors, 63.8%; beta-blockers (26.5%), diuretics (19.8%), angiotensin-receptor blockers (15.8%) and calcium-channel blockers (6.4%). Only the age (≥55 years) and BMI (>30) of the patients, and the age of the doctors (≥55 years), had an important influence on BP control. Obesity is a particular and important determinant of uncontrolled hypertension; it is worth to act on body weight, on an individual basis. As lack of control has been also tied to elderly doctors, an education programme could be envisaged.

Gender Differences in Antihypertensive Treatment: Myths or Legends?

In European countries and in the USA, hypertension represents an important risk factor for cardiovascular diseases (CVD) in men and women. Women do not perceive CVD as an important health problem, despite the evidence that women are more at risk to die from hypertension-related CVD than men. A correct prevention strategy should more widely acknowledge sex-specific risk factors, such as hypertension in pregnancy, and the benefit of treating hypertension in both men and women. In more recent years, hypertension awareness and treatment rates are higher in women than in men while blood pressure control rates are improving, but remain still lower in older hypertensive women. Differences have been described regarding the pattern of antihypertensive drug prescription and use in hypertensive men and women; women are more frequently treated with diuretics and less frequently with angiotensin-converting-enzyme (ACE)-inhibitors and angiotensin-receptors blockers. Calcium-antagonists appear to be particularly effective in women. Data from large clinical trials and meta-analyses offer strong evidence that the efficacy of the various drug classes in prevention of CV events does not differ by sex, and therefore the choice of the drug cannot be based only on this criterion in post- menopausal women. There are currently no specific blood pressure (BP) treatment goals for post-menopausal hypertension.

Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria

Hypertension has been reported as the strongest modifiable risk factor for cardiovascular morbidity and mortality. The aim of the study was to identify the most prescribed antihypertensive drugs, its patterns, comorbidities, cost of medications, and laboratory investigations. This study was a cross-sectional, descriptive study of hypertensive patients conducted at the Lagos State University Teaching Hospital, Ikeja. A total of 200 case notes were retrieved from the medical records unit over a period of 8 weeks. Information on antihypertensive prescriptions and comorbidities was retrieved. The average cost of medications and laboratory investigations was calculated. Statistical Analysis Tool Used: SPSS software version 16. The mean age of the patients was 58.44 ± 12.65 years. Of the 200 patients, 5 (2.5%) were on monotherapy and 195 (97.5%) were on combination therapy. One hundred and twenty (60%) patients had comorbidities which included congestive heart failure 55 (27.5%), diabetes mellitus 22 (11%), hyperlipidemia 15 (7.5%), and cardiovascular disease 13 (6.5%). The various classes of antihypertensive drugs prescribed were diuretics 128 (64.0%), beta-blockers 126 (63.0%), calcium channel blockers 106 (53.0%), angiotensin-converting enzymes inhibitors 103 (51.5%), angiotensin receptor blockers 33 (16.5%), alpha blockers 9 (4.5%), and fixed drug combinations 2 (1.0%). The average cost per month of the antihypertensive medications was ₦ 2045 (US$10.2). Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure. Community-based insurance scheme should be encouraged and effective implementation of integrated noncommunicable diseases screening into the primary health care services would be helpful.

Drug utilization study of anti-hypertensive drugs in a tertiary care hospital

Background: Hypertension is a major non-communicable disease and a risk factor for cardiovascular diseases. The antihypertensive drugs used for its management constitute a significant portion of the medicines prescribed in a health care centre. The aim of our study was to analyse the utilization pattern of anti-hypertensive drugs at a tertiary care hospital in accordance with the WHO prescription indicators. Methods: A prospective cross sectional observational study was carried out in the outpatient of general medicine department of Osmania General Hospital. The prescriptions of the hypertensive patients visiting the outpatient were monitored. From the data collected, the prescription pattern of antihypertensive drugs, and WHO prescription indicators, were analysed. Results: Out of the 301study subjects, 134 (44.51%) were males and 167 (55.48%) were females, with the maximum number of patients (197) falling in the age group 51-70 years. Among the antihypertensive drugs prescribed, Amlodipine was most frequently prescribed (53.15%). The frequently used drugs for monotherapy - amlodipine (26.91%) and for two drug therapy - amlodipine+enalapril (17.27%), and for three drug therapy - atenolol+enalapril+nifedipine (2.32%). The WHO prescribing indicators as analyzed from the data collected are; Average number of drugs prescribed per encounter - 5.64/prescription, Percentage of medicines prescribed by generic name - 89.22%, Percentage of medicines prescribed from essential drug list -90.17% . Conclusions: The study provides an insight into antihypertensive drug usage pattern in tertiary care hospital and their rational use. The study emphasizes the need for preventive measures and effective educative measures in the population about hypertension.

Analysis of prescribing pattern of antihypertensive drugs during pregnancy and neonatal outcome in a tertiary care centre

Background: Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 2-8%. Maternal hypertension, even of the mild to moderate category, can lead to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. Though hypertension occurs up to 8% of pregnancies, yet information on the safety of antihypertensive medication use during pregnancy is limited. The objective of this study was to analyse the prescription pattern of antihypertensive drugs in pregnant woman and also to assess the neonatal outcome in pregnant woman on antihypertensive drugs. Methods: The retrospective study includes analysis of all the prescriptions from case records of hypertensive pregnant women till the delivery for one year. Results: Total number of 122 hypertensive pregnant patients was included in the study. Mean age of the patients was 25.8 years. 51.6% were primigravida. Most of them were diagnosed after 28±2 weeks of pregnancy. 54% were on monotherapy. Most commonly used drug was alpha methyl dopa followed by nifedipine. Out of 86.9% (n=106) live birth delivered; 29.2% were of low birth weight. Conclusions: All the prescriptions were prescribed rationally. Most of the prescriptions contain monotherapy with alpha methyl dopa which is considered to be safest antihypertensives in pregnancy.

Antihypertensive prescription patterns of nonspecialist general practitioners in Lagos, Nigeria

Context: Concerns have been expressed about the antihypertensive prescription patterns of nonspecialist physicians who care for the majority of patients with hypertension in developing countries. Aims: The aim of the study was to assess the antihypertensive prescription pattern of nonspecialist general medical practitioners in Lagos, Nigeria. Settings and Design: This was a cross-sectional survey carried out among nonspecialist general medical practitioners within Lagos State, Nigeria. Subjects and Methods: A total of 132 doctors completed questionnaires about their demographics, duration and location of practice, and antihypertensive prescription patterns. Statistical Analysis Used: Continuous variables are presented as means or medians while categorical variables are presented as percentages. Comparison between means was done using the Student's t-test, while comparison between percentages was carried out using Chi-square test. Results: Majority (61.2%) considered thiazide diuretics their first choice antihypertensive. The most frequently prescribed antihypertensives were calcium channel blockers (CCBs) (88.6%), thiazide diuretics (85.6%), and angiotensin converting enzyme inhibitors (ACEIs) (84.8%). These were also the most frequently combined with the CCB-thiazide diuretic combination being the most frequently prescribed (81.1%) followed by the ACEIs - thiazide diuretic combination (65.9%). The most frequently considered factors when prescribing antihypertensive medications were side effects of the medications (92.4%), additional benefits beyond blood pressure (BP) lowering (90.9%), patients' BP at the time of presentation (89.4%), dosage frequency of the drug (87.9%), and available scientific evidence for efficacy in lowering BP (87.1%). Conclusions: The antihypertensive prescription pattern of nonspecialist physicians practicing in Lagos aligns with current hypertension treatment guidelines.

A Retrospective Observational Study to Assess Prescription Pattern in Patients with Type B Aortic Dissection and Treatment Outcome

Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes.

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.

Age Differences in Treatment and Control of Hypertension in US Physician Offices, 2003-2010: A Serial Cross-sectional Study

BackgroundEvidence-based and age-appropriate antihypertensive pharmacotherapy in outpatient settings is essential for optimal treatment outcomes. Recent guidelines, although controversial, recommended different blood pressure goals using age cutoff of 60 years. We describe recent age-specific national trends in antihypertensive prescribing patterns and blood pressure control in US office-based practices. MethodsWe analyzed all hypertension-related visits to physician offices from the latest available National Ambulatory Medical Care Survey (2003-2010). We identified trends of antihypertensive prescribing overall and by class, trends of hypertension control, age differences in antihypertensive prescribing patterns and hypertension control, predicted probabilities of hypertension control in subgroups, and correlates of hypertension control. ResultsThere were 16,729 physician office visits included in the analysis. Overall, the prescription of antihypertensive medication increased from 69.2% in 2003-2004 to 78.8% in 2009-2010 (Ptrend = .001), and the increased trend was consistent in both age groups (<60 and ≥60 years). This was accompanied by an improvement in the overall hypertension control (from 39.1% to 48.8%, Ptrend <.001). Antihypertensive prescribing patterns differ significantly between the 2 age groups. The proportions of visits with β-blocker (from 25.4% to 34.7%, Ptrend <.001) and angiotensin receptor blocker prescriptions (from 17.0% to 22.1%, Ptrend = .042) increased for older patients. The increased trend of β-blocker use persisted after excluding patients with compelling indications. Among treated patients, lower odds of blood pressure control were associated with African American race, presence of comorbidities, younger age, and insufficient insurance coverage. ConclusionsIn office-based practices, antihypertensive medication prescribing among US adults with hypertension increased significantly in recent years, which was accompanied by improvement in hypertension control. The prescribing patterns differed among younger and older patients, but continuous use of β-blockers without other compelling indications raises concerns.

Antihypertensive prescribing patterns and hypertension control in a large, urban, underserved population

Female 70.45 29.55 0.217 Male 69.63 30.37 0.217 Black 62.60 37.40 < 0.001 Nonblack 72.59 27.41 < 0.001 English Language 69.13 30.87 < 0.001 Spanish Language 74.70 25.30 < 0.001 Commercial Insurance 71.58 28.42 0.057 Medicaid Insurance 71.57 28.43 0.057 Medicare Insurance 69.02 30.98 0.057 Uninsured 70.69 29.31 0.057 Coronary Artery Disease 74.19 25.81 < 0.001 Chronic Kidney Disease 65.60 34.40 < 0.001 Diabetes Mellitus 72.87 27.13 < 0.001 ACE or ARB + CCB: Black 49.11 50.89 < 0.001

Prescription Pattern of Anti-Hypertensive Drugs in Adherence to JNC- 7 Guidelines

The main objective of the present study to investigate the utilization pattern of antihypertensive drugs in hypertensive patients and to find out whether the prescription pattern is in adherence with the JNC7 guidelines for the management of hypertension. A prospective study was conducted and drug utilization data were collected from 137 hypertensive patients who were attended as Out Patient Department (OPD) of Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India. The data was retrieved from patient’s medical records as well as from the interview of patients and their legally acceptable representatives. The following classes of antihypertensive drugs were analyzed; Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARBs), Beta Blockers (BBs), Calcium Channel Blockers (CCBs) and Diuretics. The inclusion criteria for the recruitment of study subjects were the patients suffering from hypertension with or without other co-morbid conditions. The analysis of the prescription frequency, proportion of the different antihypertensive classes of drugs as monotherapy as well as combination therapy was done. The most frequently prescribed classes of antihypertensive medications were Diuretics (mainly thiazides followed by Loop category) followed by CCBs, BBs, ACEIs and ARBs. Antihypertensive drug combination therapy was given to 72.26% of the total population while monotherapy was received by 27.73% of the total hypertensive population, representing more utilization of combination therapy as compared to monotherapy. The prescription pattern of these classes of drugs was found to be considerately in adherence to JNC7 guidelines for the management of hypertension. It was evident from the study that hypertension is more pronounced in males with increasing age as compared to females. The diuretics were the first choice alone or in combination and pattern of prescription was adhered to JNC-7 Guidelines.

A prospective drug use evaluation of antihypertensive drugs in in-patients of a tertiary referral care hospital.

Hypertension is a chronic illness associated with high morbidity and mortality. Once hypertension is diagnosed, starting antihypertensive therapy on a long-term basis along with regular follow up is important. Standardizing treatment guidelines and conducting drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to analyze the prescription patterns of antihypertensive drugs in a tertiary care referral hospital in Malabar region, Kerala, India. The study was conducted at the General Medicine and Cardiology Department involving the in-patients. Patients suffering from essential hypertension with or without other co-morbidities were included in the study. The frequency and proportion of prescribing different groups of antihypertensive drugs as monotherapy or combination therapy, and prescription of fixed drug combinations (FDCs) were analyzed. A total of 200 hypertensive patients were included in the study. Patient data were collected from in-patient's case sheets and direct interviews with the patients and their observers. The majority of the patients were females with 56%, whereas the males comprised 44%, with most of the patients suffering from stage-II hypertension. The study revealed that a high proportion of the hypertensive patients had co-morbid diabetes mellitus. The most commonly prescribed class of antihypertensive drugs was angiotensin receptor blockers, followed by calcium channel blockers and β-blockers. With regard to patient therapy, 32.0% received monotherapy, whereas 68.0% received combination therapy, 16% of which received FDCs. The study shows that clinical pharmacists can play a key role in promoting rational prescription and improving adherence to medication.

PCV113 - Racial Variations In Antihypertensive Pharmacotherapy In Ambulatory Settings: Data From United States National Samples

PCV113 RaCial VaRiations in antihyPeRtensiVe PhaRmaCotheRaPy in ambulatoRy settings: Data FRom uniteD states national samPles Chettupalli K.1, Gu A.2, Wu W.K.3 1ST JOHNS UNIVERSITY, fresmeadows, NY, USA, 2ST JOHNS UNIVERSITY, NY, USA, 3St. John’s University, Jamaica, NY, USA Objectives: Very few studies systematically investigated the differences in antihypertensive pharmacotherapy in ambulatory care settings among different racial groups. The objectives of the study include: 1) To compare antihypertensive prescription patterns by patient race in US ambulatory settings; 2) To determine factors affecting the recipient of each class of anti-antihypertensive regimen specific to racial groups. MethOds: All patient-physician encounters with primary diagnosis indicating essential hypertension (ICD-9 codes “401.0”, “401.1” and “401.9”) and patient age 18 years and older from National Ambulatory Medical Care Survey (NAMCS) for the years 2006-2010 were analyzed. Weighted univariate and bivariate analyses were performed to examine demographics and clinical characteristics in general and between the racial/ethnic groups. Multivariate logistic regression models were performed to investigate the adjusted likelihood of receiving each class of antihypertensive regimens by different racial groups, controlling for potential confounders. Results: A total of 12,674 visits were identified. The unadjusted prescription rates by race (African Americans vs. Caucasians) were 23.1% vs. 20.3% (diuretics), 21.9% vs. 29.5% (BBs), 21.2% vs. 26.5% (ACEIs), 18.5% vs. 16.7% (CCBs), 14.5% vs. 14.8% (Angiotensin II Receptor Blockers, ARBs), 6.6% vs. 5.9% (Antiadrenergic agents), and 47.2% vs. 45.2% (combination regimens). Weighted logistic regression analyses determined that African Americans were more likely to receive diuretics (OR= 1.396, P< .0001), Calcium Channel Blockers (BBs) (OR= 1.409, P< 0.0001), Anti-Adrenergic-agents (OR= 1.267, P= 0.0275), fixed-dose combinations (OR= 1.273, P= 0.0027), and multiple-pill-regimens (OR= 1.184, P= 0.0048) and less likely to receive ACEIs ( OR= 0.836, P= 0.0080), BBs (OR= 0.73, P< 0.0001) than Caucasians. Factors affecting the likelihood of receiving different classes of antihypertensive agents include patient age, gender, co-morbid conditions, insurance-status, and health education profile. cOnclusiOns: In US Ambulatory Care Settings, African American patients receive systematically different antihypertensive regimens than their Caucasian counterparts. Further studies are needed to disentangle the potential effects from health insurance and utilization patterns on the racial variations in antihypertensive pharmacotherapy.

Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women.

Aim of Study:The aim of this study is to evaluate antihypertensive drug prescription patterns, rationality and adherence to Joint National Committee (JNC-7) hypertension (HT) treatment recommendations among Indian postmenopausal women (PMW).Materials and Methods:An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year. A total of 500 prescriptions prescribed to PMW for diagnosed HT, were identified for one point analysis. Drug prescription patterns/trends, and their adherence to JNC-7 report as well as rationality using WHO guide to good prescribing was assessed.Results:In the monotherapy, category angiotensin receptor blockers (ARBs) accounted (24.8%), calcium channel blockers (CCBs) (19.4%), angiotensin converting enzyme inhibitors (ACEIs) (11%), beta blockers (BBs) (2.8%), and diuretics (2%) of the total prescription. Individually, amlodipine was maximally prescribed in 16.4%. 31.6% had double combination, whereas 2.2% and 1% had triple and four drug combinations, respectively. About 3.6% of the prescription contained antihypertensive combination along with other class of drug. ARBs + diuretic were observed in 11%, CCBs + BB 10% and ACEI + diuretic in 2.6% of the total prescriptions. Among the combination therapy amlodipine + atenolol (8.4%), telmisartan + hydrochlorothiazide (6%) and losartan + hydrochlorothiazide (4.4%) were maximally prescribed. 84.21% (P < 0.001) of the prescription showed nonadherence as per recommendations for pre-HT. 100% and 43.25% adherence rates were noticed for Stage 1 HT (P < 0.001) and Stage 2 HT (P > 0.05) patients.Conclusion:Antihypertensive prescription trends largely adhere to existing guidelines and are rational except polypharmacy, generic and fixed dose combinations prescribing, were some of the common pharmacologically considered irrationality noticed.