Trends in Antihypertensive Medicine Utilization in the Republic of Srpska, Bosnia and Herzegovina: An Eleven-Year Follow-Up (original) (raw)
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Journal of Human Hypertension, 2006
Variation in antihypertensive drug utilization and guideline preferences between six European countries (Denmark, Finland, Germany, Norway, Sweden, the Netherlands) was investigated. Our objectives were to compare between-country variability in utilization per class of antihypertensive agents and to assess guideline preferences in relation to actual use. Antihypertensive consumption data (2003) was retrieved. We classified antihypertensive agents using ATC-codes: C02CA-alpha-blockers (AB), C03A-thiazide diuretics (TD), C07AB-beta-blockers (BB), C08CA-dihydropyridine calcium antagonists (CA), C09A/C09BA/C09BB-ACE-inhibitors þ combinations (AI) and C09C/C09Dangiotensin II receptor blockers þ combinations (AT2). For each class, DDDs/1000 persons/day and share (%) of total antihypertensive utilization was calculated. Per class, relative standard deviations (RSD) across countries were computed. Current hypertension guidelines were requested from national medical associations. Total antihypertensive utilization varied considerably, ranging from 152.4 (Netherlands) to 246.9 (Germany) DDDs/1000 persons/day. RSD was highest for TD (106.2%) and AB (93.6%). Where guidelines advocated TDs (Norway and Netherlands), TD utilization was below (Norway) or just above (Netherlands) median TD use. Guidelines recommended TD (Norway and Netherlands), TD/BB/AI (Finland, German Physicians Association) or TD/BB/CA/AI/AT2 (Denmark, German Hypertension Society), Sweden had no recent national guideline. In conclusion, antihypertensive utilization patterns varied largely across these six countries, in absolute and relative terms. Furthermore, guidelines seem disconnected from clinical practice in some countries, and none of the guidelines discuss current utilization. Whether this reflects a need for change in prescribing or re-evaluation of guidelines warrants further research.
European Journal of Clinical Pharmacology, 2007
Objectives The prescribing pattern of drugs used for treating hypertension changes over time in response to changes in recommended guidelines and innovations in drug formulations, among others. In addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study was to investigate the practice of antihypertensive medications in primary care units in Turkey. Method TURKSAHA is a cross-sectional screening study conducted in 1000 primary care units considered to be representative of primary care in Turkey, with the purpose of defining the demographic characteristics, clinical features, rate of blood pressure control achieved and the antihypertensive drugs prescribed for the hypertensive patients treated in these centers. In this analysis, we investigated the agents used in the treatment regimen. Results Of the 16,270 patients considered to be eligible for inclusion in the study, 15,187 (93.3%) were on an antihypertensive treatment, and 1083 (6.7%) were receiving no treatment. Patients who received treatment but whose antihypertensive medication was not specified (2290 patients) were subsequently excluded, and the trial was carried out with the remaining 12,897 patients. The mean age of the patients was 60±11 years (60.2% female). Of the 12,897 patients, Eur 75.7% were receiving monotherapy, 19.7% two drugs, 4.1% three drugs and 0.5% four or more drugs. The rate of successful blood pressure control (<140/90 mmHg; for diabetics <130/80 mm Hg) in relation to the number of drugs received was 26.3, 25.9, 24.5 and 26.2%, respectively. Among the patients receiving monotherapy, the most frequently used antihypertensive drug class was angiotensinconverting enzyme inhibitors (30.1%), followed by β-blockers (20.6%), calcium-channel blockers (17.9%), diuretics (15.4%) and angiotensin-receptor blockers (14%). Conclusion As in other European countries, the rate of successful blood pressure control was low among hypertensive patients receiving treatment, and despite the inadequacy of monotherapy to control blood pressure, many of the patients continued this treatment regimen. Consistent with the global trend, the most frequently prescribed anti-hypertensives were angiotensin blockers.
Background/Aim. Hypertension is one of the leading causes of cardiovascular morbidity and mortality and more than a half of all health insurance expenditures for reimbursed medicines are allocated to antihypertensive drugs in Serbia. The aim of this study was to identify the antihypertensive drug utilization patterns among hypertensive outpatients in the city of Novi Sad, Serbia, determine the adherence to clinical guidelines and address the economic aspects of current prescribing practices. Methods. This retrospective observational study was conducted in Novi Sad over a period of six months. The data on the number of packages, size of packages, and retail price of antihypertensives issued on prescription in outpatients with the diagnosis of essential arterial hypertension was collected from all state-owned pharmacies in Novi Sad. Drug consumption was analyzed using the Anatomical Therapeutic Chemical (ATC)/ defined daily dose (DDD) methodology. Results. Total consumption of antihypertensives issued on prescription over 6 month period in the city of Novi sad, Serbia was 283,48 DDD per 1,000 inhabitans per day (DID). Angiotensin converting enzyme inhibitors (ACEi) were most commonly prescribed drugs, and were used 3 times more often than calcium channel blockers and 5 times more than betablockers. The consumption of diuretics and angiotensin receptor antagonists was low within all groups of outpatients. Both national and international guidelines state superiority and effectiveness of diuretics in treatment of hypertension in the elderly, but their consumption was unreasonable low despite the fact that over 70% of all antihypertensive drugs in the city of Novi Sad were dispensed in people aged > 60. The use of more expensive ACEi was observed, despite the guidelines deeming all the drugs of these class equally effective in treatment of hypertension. Conclusion. Large differences in utilization of different groups of antihypertensive agents were noted in this study. Underutilization of valuable, efficacious, and cost-effective thiazide diuretics and over use of expensive ACE inhibitors is unjustifiable. There is a potential for large savings with switching to low-price ACEi, modeling the practice of Scandinavian countries. Key words: antihypertensive agents; serbia; cost-benefit analysis; economics, pharmaceutical; drug utilization review. Apstrakt Hipertenzija je jedan od vodećih uzroka kardiovaskularnog morbiditeta i mortaliteta u Srbiji, te više od polovine troškova za lekove na teret osiguranja odlazi na antihipertenzivne lekove. Cilj ove studije bio je analiza strukture upotrebe antihipertenzivnih lekova kod hipertenzivnih vanbolničkih pacijenata u Novom Sadu, usklađenosti sa farmakoterapijskim uputstvima i ekonomskih aspekta trenutne prakse propisivanja. Metode. Podaci o prometu i potrošnji antihipertenzivnih lekova propisanih kod vanbolničkih pacijenata sa dijagnozom esencijalne arterijske hipertenzije u šestomesečnom periodu prikupljeni su u državnim apotekama u Novom Sadu. Lekovi su klasifikovani prema anatomsko-terapijsko-hemijskoj klasifikaciji lekova i izračunate su definisane dnevne doze na hiljadu stanovnika na dan (DID). Rezultati. Ukupna potrošnja antihipertenzivnih lekova izdatih na recept u periodu od šest meseci u Novom Sadu bila je 283,48 DID. Najčešće korištena grupa lekova bili su inhibitori angiotenzin konvertujućeg enzima (ACEi), koji su propisivani tri puta češće od kalcijumskih antagonista i pet puta više od beta blokatora. Iako uputstva za lečenje hipertenzije navode da su svi ACEi jednako efikasni, primećena je upotreba skupljih ACEi. Upotreba diuretika i antagonista receptora angiotenzina bila je niska u posma- Page 2 VOJNOSANITETSKI PREGLED Tomas A, et al. Vojnosanit Pregl 2016; Online First March (00): 47–47. tranom periodu. Farmakoterapijska uputstva naglašavaju prednost i efikasnost diuretika u lečenju hipertenzije kod starijih osoba, ali njihova potrošnja bila je neopravdano niska, uprkos činjenici da je preko 70% svih antihipertenzivnih lekova u Novom Sadu propisana pacijentima starijim od 60 godina. Zaključak. Ovo ispitivanje pokazalo je velike razlike u propisivanju različitih grupa antihipertenzivnih lekova. Nedovoljno korišćenje tiazidnih diuretika, lekova sa najboljim odnosom koristi i troškova i upotreba skupih ACE inhibitora je neopravdana. Postoji mogućnost za značajne uštede sa racionalnijom upotrebom ACEi, po uzoru na Skandinavske zemlje. Ključne reči: antihipertenzivi; srbija; troškovi-korist, analiza; farmakoekonomika; lekovi, korišćenje, izveštaji.
Antihypertensive drug prescription trends at the primary health care centres in Bahrain
Pharmacoepidemiology and Drug Safety, 2001
Purpose To determine the antihypertensive drug prescribing pattern by primary care physicians in patients with uncomplicated essential hypertension; to identify whether such pattern of prescription is appropriate and in accordance with international guidelines for pharmacotherapy of hypertension; and to estimate the impact of such prescriptions on cost of treatment.
Impact of New Antihypertensives on Healthcare Utilization by Hypertensive Patients
American Journal of Pharmacy Benefits
Objective: To investigate the hypothesis that adoption of newer antihypertensive medications is associated with decreased healthcare utilization in patients with hypertension. Study Design: Retrospective follow-up study. Methods: Hypertensive patients were identified during the first round of the 1999 Medical Expenditure Panel Survey database and followed until the end of the year. Antihypertensive drugs approved by the US Food and Drug Administration (FDA) in 1996-1998 were defined as new antihypertensive drugs. New drug adopters were those hypertensive patients who were prescribed at least 1 new antihypertensive medication. Total healthcare expenditures, nondrug healthcare expenditures, and emergency department (ED) visits were the variables signifying healthcare utilization. Results: The FDA approved 14 new antihypertensive drugs in 1996, 1997, and 1998. Of the 1149 patients who met inclusion criteria, 63 (5.48%) were new drug adopters. The total healthcare and nondrug healthcare expenditures of the new drug adopters were found to be 1.63 (P = .019) and 1.78 (P = .013) times higher, respectively, than they were for patients who were not new drug adopters. The difference in ED visits between the 2 groups was not significant (P = .089). Conclusion: Adoption of new antihypertensive drugs led to higher healthcare costs with no significant difference in ED visits compared with old antihypertensive drugs. This result signifies the need to do a pharmacoeconomic evaluation of each new drug before acceptance by formulary strategists, physicians, and pharmacy managers.
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.
Drug utilization pattern of antihypertensive drugs at tertiary care teaching hospital
International Journal of Advanced Research in Medicine, 2020
Introduction: Hypertension represents a major health problem primarily because of its role in contributing to the initiation and progression of major cardiovascular diseases. This cross-sectional observational study aims at analysing the utilization pattern of antihypertensives used for the treatment of hypertension at a tertiary care hospital in perspective of standard treatment guidelines. Materials and Methods: This is a prospective, cross sectional and observational study carried out in the outpatient of Department of General Medicine of NC Medical College and Hospital. All patients with proven hypertension and put on antihypertensive medications were recruited from the Department of Medicine. The total duration of the study was 1 year i.e. December 2019 to November 2020. Results: In our study, the mean systolic blood pressure (mean±S.D) of the patients was 154.34±9.43 and the median was 153. Test of proportion showed most of the patients 53 (44.1%) were significantly higher systolic blood pressure ranging from 160-179 mmHg. The mean diastolic blood pressure (mean±S.D) of the patients was 98.32±8.43. Test of proportion showed most of the patients 51 (42.5%) were significantly higher diastolic blood pressure ranging from 100-119 mmHg. Test of proportion showed most of the patients 62 (51.6%) were on Mono therapy significantly higher than dual therapy, triple therapy and poly therapy, 34 (26.6%), 13 (10.8%), 11 (9.1%) respectively. Causality assessment of ADRs was done using WHOUMC scale which categorizes ADRs as "certain", "probable", "possible" and "unlikely". Table 8 shows that type of reactions and their percentage are as certain (9.6%), Probable/ Likely (67.7%), Possible (19.3%), and Unlikely (3.2%). Conclusions: In this study usage of anti-hypertensive drugs were prescribed rationally in tertiary care hospital. The study emphasizes that need for effective continuing medical education and also preventive measures in hypertensive individuals.
Prescription pattern of Anti-hypertensive drugs in a tertiary care hospital
Background: Elevated Blood pressure is one of the most important modifiable risk factors for cardiovascular diseases. Recently a number of newer and effective anti-hypertensive medications have come into practice. Therefore it is important to find out patient compliance, recent trends in prescribing anti-hypertensive medications and its effectiveness in upcoming medical practice. Objective: To evaluate the recent trends in prescribing anti hypertensive drugs, in outpatients in the Departments of General Medicine and Cardiology at a tertiary care hospital. Methods: The present study was a cross sectional observational study. This was conducted in the Departments of Cardiology and General Medicine, Pondicherry Institute of Medical Sciences (PIMS), Puducherry. Adult patients diagnosed to have mild to severe systemic hypertension and on treatment without any other co morbid conditions of either sex attending the out patient clinic were included in the study. The study duration was three months with a sample size of 300 patients. The following data were obtained from their outpatient files: Demographic details, BP, drugs used to treat the elevated BP. The data will be presented as descriptive statistics. Results: Majority of patients were between the age groups of 41-60 years. Amongst them 84% of male patients and 61.90% of female patients had good control of BP with anti-hypertensive therapy. 71.70% of patients had their BP within the normal range with a single anti-hypertensive drug. The most commonly prescribed drug is calcium channel blockers followed by beta-blockers, ACE inhibitors, ARBs and diuretics. The most commonly used combination is calcium channel blocker with beta-blocker. Conclusion: The present study represents the current prescribing trend for anti-hypertensive agents. The use of single anti-hypertensive has been found to provide good control of blood pressure in majority of patients, but about 28% of patients required more than one drug for blood pressure control. Though the rate of usage of AR blockers and ACE inhibitors has been increasing, the Calcium channel blockers and β blockers top the list in the most commonly prescribed anti-hypertensive agents.
To investigate which antihypertensive drug is the most popular prescription amongst Physicians
Pakistan Journal of Medical and Health Sciences, 2021
Background:Globally, hypertension has been recognized as a main health problem for under developed as well as developed countries. It can also be defined as a non- transmittable illness due to its high rate of death and delay in early diagnosis, it is called “silent killer”. There are limited research findings available in Pakistan forassessing it’sprevalenceand no latest researches are carried out. Objective: The main goal of current research is to investigate which antihypertensive drug is the most popular prescription amongst Physicians. Material and Methods:It was a cross sectional descriptive studyperformed at the pharmacologysection, Lahore Medical and Dental College (LMDC). All adult participants (20 ≥ 50 ≤ years) for the period of11thto 20th April 2017.After taking informed permission from all the participants were enrolled. A questionnaire was used to collect the dataand analyzed by using SPSS 20. A comparative test was used to compute results. Results:50 participants were ...