An Analysis of Prescription Patterns in Cases of Uncomplicated Hypertension In A Tertiary Care Hospital
Prescription Patterns in Cases of Uncomplicated Hypertension
DOI:
https://doi.org/10.70284/njirm.v3i1.1958Keywords:
Combination therapy, Diuretics, monotherapy, Uncomplicated hypertensionAbstract
Background & objectives- Prescribing pattern in hypertension patients were found to be different
from the recommended guidelines in the past. The objectives of the present study were to analyze prescribing
trends in uncomplicated hypertension and to compare with those of current international guidelines with the
objective to note any deviation. Methods- A prescription based analysis in 1400 hundred uncomplicated
hypertensives in the age group 30 to 60 years was carried out. Results- Monotherapy was prescribed to 893
cases (M 407; F 486) and combination therapy to 507 cases (M 342; F 165). Overall, Calcium Channel Blockers
(CCBs) were the most common agents used 787 (56.21%) cases, 350 monotherapy and 437 as combination
therapy. Angiotensin Converting Enzyme Inhibitors (ACE I) 452 (32.28%) and Angiotensin II Receptor Blockers
(ARBs) 231 (16.5%) cases were the next preferred groups. In double drug combination CCB+ Beta Blockers (BB)
and for triple drug combination CCB+ARB+ Diuretics (D) were more preferred. A significant effect of age
(p<0.01) on prescription of CCBs was noted. Prescription of ARBs and D were significantly (p<0.05 and <0.01
respectively) influenced by gender. Gender had no significant effect on the prescribing trend of
antihypertensive agents in combination therapy, while a significant effect (p<0.05) of age and combined drug
classes CCB+ACE I and CCB+BB+D was noted. The overall prescription rate for diuretics was 40.24% and that
for monotherapy was meagre 5.15% (M 1.23%±; F 3.92%). Diuretics were always prescribed in triple drug
combinations. Interpretation & Conclusions- CCBs were the most commonly prescribed agents. A deviation
existed between antihypertensives prescribed and current international guidelines thus calling upon greater
awareness.
References
relevance of usual blood- pressure to vascular
mortality meta analysis of individual data for
one million adults in 61 prospective studies.
Lancet 2002; 360:1903-13.
2. Fields LE, Burt VL, Cutler JA et al. The burden of
adult hypertension in the United States 1999 to
2000: A rising trend. Hypertension. 2004;
44:398-404.
3. Kearney PM, Whelton M, Reynolds K et al.
Global burden of hypertension analysis of
worldwide data. Lancet. 2005; 365: 217-23.
4. Martinelli LM, Mizutani BM, Mutti A et al.
Quality of life and its association with
cardiovascular risk factors in a community
health care program population. Clinics. 2008;
63:783-88.
5. Jones DW, Hall JE. Seventh Report of The Joint
National Committee on Prevention, Detection,
Evaluation, and Treatment of High BloodPressure and Evidence from New Hypertension
Trials. Hypertension. 2004; 43:1-3.
6. Ramsay L, Williams B, Johnston G et al.
Guidelines for management of hypertension:
report of the third working party of the British
Hypertension Society. J Hum Hypertens. 1999;
13: 569-92.
7. World Health Organization/ International
Society of Hypertension (WHO/ ISH). Guidelines
for the management of mild hypertension. J of
Hypertension. 1999; 17:151-183.
8. Liu P and Derwang J. Antihypertensive
medication prescription patterns and time
trends for newly diagnosed uncomplicated
hypertension patients in Tiawan. BMC Health
Services Research. 2008; 8:133-42.
9. Sweileh W. Pharmacotherapeutic Analysis and
Prescription Pattern of Antihypertensive Drugs
Dispensed at Community Pharmacies in
Palestine. An- Najah Univ. J Res(N. Sc). 2003;
17(2): 167-79.
10. KA Jassim, AI Khaja, RP Sequeira et al.
Antihypertensive drug prescription trends at
the primary health care centres in Bahrain. Ann
Pharmnacother. 2001; 35: 1350-59.
11. Siegal D, Lopez J. Trends in antihypertensive
drug use in the United States- do the JNC V
recommendations affect prescribing? Fifth Joint
National Committee on the Detection,
Evaluation, and Treatment of High Blood
Pressure. JAMA. 1997; 278: 1745-48.
12. Pahor M, Psaty BM, Alderman MH et al. Health
outcomes associated with calcium antagonists
compared with other first-line antihypertensive
therapies: a meta-analysis of randomized
controlled trials. Lancet. 2000; 356: 1949-54.
13. Nelson CR, Knapp DA. Trends in
antihypertensive drug therapy of ambulatory
patients by US office-based physicians.
Hypertension. 2000; 36: 600-03.
14. Hanson L, Lindholm LH, Ekbom T et al.
Randomized trial of old and new
antihypertensive drugs in elderly patients:
cardiovascular mortality and morbidity the
Swedish Trial in Old Patients with Hypertension-
2 Study. Lancet. 1999; 354:1751-56.
15. Crucitti A, Cecchi E, Gensini GF et al. Use of
antihypertensive drugs in the Italian Hospitals.
Pharmacologic Research. 2000; 41(2): 249-53.
16. Neutel CI, Campbell NRC. Antihypertensive
medication use by recently diagnosed
hypertensive Canadians. Can J Cardiol. 2007;
23(7): 561-65.
17. Sweileh WM and Jaradat NA. Sex differences
and Disease Factors Affecting Monotherapy
Choice for Hypertension. The Islamic University
Journal. 2006; 14(1): 51-61.
18. Visser LE, Stricker BHch, vander Valden J et al.
Angiotensin converting enzyme inhibitor
associated cough: a population based casecontrol
study. J Clin Epidemiol. 1995; 48:851-57.
19. Ma J, Lee KV, Stafford RS. Changes in
antihypertensive prescribing during US
outpatient visits for uncomplicated
hypertension between 1993 and 2004.
Hypertension. 2006; 48:846-52.
20. Walley T, Duggan AK, Haycox AR et al.
Treatment of newly diagnosed hypertension:
patterns of prescribing and antihypertensive
effectiveness in the UK. J R Soc Med. 2003; 96:
525-31.
21. Fretheim T, Oxman AD. International variation
in prescribing antihypertensive drugs: its extent
and possible explanations. BMC Health Serv
Res. 2005; 5:21.
22. Neal WW. Reducing costs and improving
compliance. Am J Cardiol. 1989; 63: 17B-20B.
23. Mason J, Eccles M, Freemantle N et al. A
Framework for incorporating cost-effectiveness
in evidence-based clinical practice guidelines.
Health policy. 1999; 47: 37-52.
24. Goodman B. Do drug company promotions
influence physician behaviour? West J Med.
2001; 174: 232-33.
25. Cushman WC, Ford CE, Cutler JA et al. ALLHAT
Collaborative Research Group. Success and
predictors of blood pressure control in diverse
North Am settings: the antihypertensive and
lipid-lowering treatment to prevent heart attack
trial (ALLHAT). J Clin Hypertens (Greenwich).
2002; 4:393-405.
26. The Sixth Report of the Joint National
Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure. Ann Intern Med. 1997; 157:2413-46.
27. Kaplan NM. Should low-dose combination
therapy be preferred first-line treatment for
hypertension: Predicting JNC 7. Am J Hypertens.
2000; 13: 329A-329A.
