Antihypertensive Prescription Patterns Research Articles

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 & ESC/ESH guidelines majority of the  prescription patterns were achieved and found optimal at the study  site. 

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.

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. 

Difference in Antihypertensive Medication Pattern in the First Year Compared to More than a Year of Maintenance Hemodialysis: A Northern India Tertiary Care Experience

Abstract Introduction There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods In this cross-sectional study, patients on maintenance hemodialysis, aged ≥18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ≤12 months and &gt;12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results Out of 250 patients, 131 had a dialysis vintage of ≤12 months, whereas 119 had a vintage of &gt;12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ≤12 and &gt;12 months' vintage groups) and β blockers (64.12 and 65.54%, respectively, in ≤12 and &gt;12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ≤12 months' group, whereas carvedilol usage was higher in &gt;12 months' group (p = 0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in &gt;12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence.

Prescription audit of antihypertensive drugs used in stroke patients in a tertiary care teaching hospital

Background: Stroke is considered as one of the important reasons of death and disability worldwide. A rational use of medications is needed to prevent the recurrence and the disease related complications.Methods: The current study is a prospective observational study. All stroke cases, with patients above the age of 25 and treated with antihypertensive agents were included in the study. A total of 189 patients were found suitable for inclusion in the study. Using a suitably designed data collection form, all pertinent data such as patient demographics, prescribed medicines, drug interactions and adverse drug reactions were collected from the patient’s case file, nurses’ charts, and medication charts. Prescription pattern of antihypertensive drugs were obtained. The causality of the ADR was assessed using the Naranjo causality assessment scale and reported in the institution where the study was conducted.Results: Majority of patients included in the study were in the age group of 61-70 years. The incidence of stroke in this study was more in males than in the females. Ischemic stroke (72%) was more prevalent when compared to Hemorrhagic stroke. Among the antihypertensive agents, calcium channel blockers (32%) were the most commonly prescribed class of drugs. In our audit, drug related problems were observed in 27% of the cases which included cases with improper dose (3 cases), contraindications (4 cases), major drug interactions (20 cases), and adverse drug reactions (17 cases). Most of the prescriptions were legible. Drug related problems had a great impact on the overall stroketherapy.Conclusions: The drug related problems are a relevant aspect to be considered when treating patients with stroke and it can arise irrespective of adherence to guidelines.

Prescription pattern of anti-hypertensive drugs in Chitwan Medical College Hospital

Background and Objectives: Hypertension is a crucial health issue globally. Cardiovascular and kidney disease is one of the results of hypertension which remarkably confer to overall mortality. Thus, the aim of this study is to investigate the prescribing pattern of anti-hypertensive drugs to hypertensive patients and also to establish the current trend of prescribing pattern of anti-hypertensive drugs at Chitwan Medical College (CMC).&#x0D; Material and Methods: A descriptive cross-sectional study was conducted among 290 patients to assess the prescribing pattern of anti-hypertensive drugs from hypertensive patients visiting medicine OPD of CMC during study period and fulfilling the inclusion criteria. A standard proforma was used to collect information about patient’s socio-demographic details and anti-hypertensive drugs used for them. Data was collected, compiled and analyzed by using Statistical Package of Social Science (SPSS) version 16.&#x0D; Results: Out of 290 prescriptions, 201 (69.3%) patients received monotherapy while only 89 (30.7%) patients received combination therapy. In monotherapy, calcium channel blockers (CCBs) and Angiotensin receptor blockers (ARBs) were most commonly prescribed, while angiotensin receptor blockers (ARBs) + diuretics were the most commonly prescribed combination therapy.&#x0D; Conclusion: In the present study, it was found that CCBs and ARBs were the most commonly prescribed anti-hypertensive drug in monotherapy.  

Pattern of Antihypertensive Drugs Prescribed in a Tertiary Care Hospital in Western India

Hypertension is a leading cause of cardiovascular morbidity and mortality. Although known as disease of old age, younger population is at increasing risk due to various factors including obesityand diabetes. Antihypertensive drug treatment being the only measure to control the raised blood pressure, large number of patients remain untreated or inadequately treated. Prescription pattern studies are needed to optimize and control the drug treatment. Present study was done with the aim to study the prescription pattern of antihypertensive drugs in a tertiary care hospital in western India.Pattern of drugs prescribed whether in combination or as single drug in various comorbidities were the objectives of the study. It was observed that ARB was the most commonly prescribed drug (41.5%) either alone or in combination. Multidrug therapy being the preferred treatment (56%), combination of ARB, CCB and Diuretic was the most common (35.7%). Diabetes mellitus was the most commonly associated comorbidity in hypertensive patients (39%), with ARB and CCB as the preferred antihypertensive drugs used in them. The treatment prescribed seemed to be specific to age, comorbidity and was in accordance with national and international guidelinesincluding the Indian Guidelines on Hypertension.