Cost Effectiveness Analysis of Antihypertensive Drugs Usage by Combination of ACEI – CCB And ACEI – Diuretic in Outpatient Hypertension Therapy at Mintohardjo Navy Hospital Jakarta Period July-November 2015 (original) (raw)
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Indian Research Journal of Pharmacy and Science, 2018
Background: Hypertension is the continuous increased arterial blood pressure. More than 25 antihypertensive agents are present for therapy according to patient factors. Administration of agents depends on the scale of therapy according to degree of hypertension. Aim: To follow up the model use of antihypertensive agents in hypertensive Jordanian subjects for hypertension control. Methods: This prospective and double blind investigation included 211 outpatient adult hypertensive participants having or not other Comorbid diseases , aged 30-70 years, of both sexes and who visited the general medicine clinic at Prince Hashim military hospital, Zarqa, JORDAN, during the period Apr 2016-Feb 2018. The data's for use of antihypertensive agents were collected from patient's medical files. The antihypertensive agents included were: Beta Blockers (BBs), Diuretics, Angiotensin Converting Enzyme Inhibitors (ACEI), Calcium Channel Blockers (CCBs), and angiotensin receptor blockers (ARBs) .Antihypertensive agents use prevalence and percentage as single or multiple therapy was evaluated. Z test was used to record the P value of age difference between two sexes. P value was considered statistically significant if it was less than 0.05. Results: The most commonly single used antihypertensive agents were Angiotensin Converting Enzyme Inhibitors (ACEI) (28.3%). In decreasing order come: Calcium Channel Blockers (CCBs) (23.3%), BBs (Beta Blockers)(18.3%), angiotensin receptor blockers (ARBs) (18.3%) and diuretics(11.7%). Multiple therapies was administered more in 71.6% (151) of patients than single therapy which was administered in 28.4% (60) of patients. Hypertension was more in men with increasing age than women. Conclusion: Angiotensin Converting Enzyme Inhibitors were the commonest antihypertensive used agents whether in single or multiple therapies.
Selecting antihypertensive medication in patients with essential hypertension in Malaysia
The Medical journal of Malaysia, 2009
The more recently published ACCOMPLISH trial randomized 11,506 hypertensive patients either to benazepril plus amlodipine or benazepril plus hydrochlorothiazide, thus testing whether it is better to combine ACEI with CCB or diuretic 15. The trial was pre-terminated after 36 months when the composite primary cardiovascular end-point was clearly lower in the ACEI-CCB arm (9.6% vs 11.8%, RR 0.80, 95%CI 0.72-0.90, p<0.001). Since ALLHAT suggested that the CCB was inferior to diuretic, this result from ACCOMPLISH must at first appear confusing. On closer inspection, in ACCOMPLISH, from the same initial BP of 145/80 mm Hg the ACEI-CCB arm ended with the lower systolic (0.9 mm Hg, p<0.001) and diastolic BP (1.1 mm Hg, p<0.001). Thus the result from ACOMPLISH is not different from ALLHAT in showing that the arm with the significantly lower achieved BP had the lower clinical outcome. The consistent message
Objective: Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. A large number of antihypertensive drugs alone or in various combinations are available, and physicians need to choose most appropriate drug for a particular patient. Pharmacoeconomic and drug utilization studies at regular intervals help physicians to prescribed rational drugs with high efficacy along with minimal cost. Methods: The prospective observational study was conducted at Seth H. J. Mahagujarat Hospital from July to December 2013. 250 hypertensive patients, attending medicine outpatient department were included for drug utilization study and 100 hypertensive patients, attending in patients department were included for pharmacoeconomics analysis during the study period. Result: The most frequently prescribed antihypertensive drug as monotherapy, as combination therapy and in fixed dose combinations was calcium channel blocker (Amlodipine). Generic drugs showed same efficacy as brand drug, but both drugs were significantly differed in the prize. Among 100 inpatients admitted for the hypertensive condition in general ward total of direct medical cost was 65.19% and total of indirect medical cost was 34.81%. β-blocker and diuretics were the most effective therapy which is followed by the clonidine, envas (Enalapril), and then, amlodipine. Conclusion: We concluded from this study that use of β-blockers and diuretics were most cost-effective for the hypertensive patients in this study.
Comparative Effectiveness Study of Combined Antihypertensives for Nigerian Patients
Asian Journal of Pharmaceutical and Clinical Research
Objective: The objective of the study was to compare the clinical and economic effectiveness of four combination antihypertensives recommended for Nigerians. Methods: An open, randomized, controlled, and longitudinal double-blind trial of four groups of antihypertensives combinations: Telmisartan/ chlorthalidone/amlodipine (TCA), TC, CA, and TA was conducted among hypertensive patients. The participants were recruited from three hospitals in Enugu, and randomly assigned to the study groups. The primary outcome for this study was blood pressure (BP) control, based on Joint National Committee-8 and cost per BP control. The secondary outcomes were cost per quality adjusted life years (QALY) and patients’ self-reported health status. Descriptive and inferential statistics were used for statistical analysis. Results: Of the 110 patients enrolled in the study, more than half were women (55.5%). The mean age of patients was 54.93±12.38. The enrollees had hypertension for over 9 years (9.17...
Comparative Use of Different Antihypertensive Combinations at Savar Area, Dhaka, Bangladesh
2014
Antihypertensive agents are class of drugs that are used to treat hypertension (high blood pressure) as well as other CVS disorders. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. Single-dose combination antihypertensive therapy is an important option that combines efficacy of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance compliance as compared to monotherapy. The survey enabled to monitor 500 prescriptions and found most available combinations at Savar area in Bangladesh among which beta blockers with Ca-channel blockers was used most (89%) and the brand Fixocard of Incepta was the brand leader.
Evaluation of anti-hypertensive drug utilisation and cost in Hospital Tengku Ampuan Afzan, Kuantan
IIUM Medical Journal Malaysia, 2020
Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure.Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel ...
Determination Medical Parameter and the Most Effective Antihypertensive
Kirkuk University Journal-Scientific Studies, 2013
Hypertension is one of the major modifiable risk factors for coronary heart disease, stroke, peripheral vascular disease and renal failure. The aim of treating hypertension is to maximize therapeutic efficacy without untoward side effects. The study population was carried out in emergency department of Razgary and Jumhury hospitals in Hawler. Hypertension was highly prevalent among aged persons between 61-70 years 33(27.5%) while the lowest percentage were recorded in the age group 30-40 years 8(6.6%). Female population showed higher percentage 53.3% than male 46.6%.Duration of hypertension more than five years 80 (66.6%) which was higher than those less than two years 8 (6.6%). Family history of hypertension appeared as strong risk factor of hypertension that recoded 76(63.3%). According to educational level found the hypertension was higher in Illiterate-primary education 55 (45.8%) than Intermediate-secondary school education 38(31.6%) and lowest among highest educational level 27(22.5%). Body mass index (BMI) had effect on percentage of hypertension among overweight patients 62 (51.6%) followed by obesity39 (32.5%)and lowest in patients with normal weight 19(15.8%). Co-morbidity was observed in70(58.3%)among which diabetes mellitus was28(23.3%)followed by cardiovascular disease 19(15.8%) and hypercholesterolemia was11(9.1%). Types of drug used to treat hypertension show diuretics and angiotensin converting enzyme inhibiter were the most drug used 26(21.6%) and 25(20.8%) respectively followed by combined drug and calcium channel blocker were 19(15.8%),18(15%) respectively then angiotensin receptor blocker17(14.1%)and beta-blocker used in 15(12.5%).
Drug Utilisation Study in the Treatment of Hypertension in a Tertiary Care Hospital
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Hypertension, a common clinical problem is considered as an 'iceberg disease' because its unknown morbidity far exceeds the known morbidity. In terms of attributable deaths, it is one of the leading behavioural and physiological risk factors amounting to 13% of global deaths. Drug selection is based on efficacy in lowering BP (blood pressure) and in reducing Cardiovascular (CV) endpoints like stroke, myocardial infarction and heart failure. This study was carried out to evaluate the pattern, extent, rationality and frequency of the use of antihypertensive drugs in the treatment of hypertension. The aim of the study is to analyse drug utilisation in the treatment of hypertension in a tertiary care hospital. MATERIALS AND METHODS This study was conducted during January 2014 to December 2015 in Medicine OPD (Outpatient Department) in a tertiary care hospital. The sample size was selected as per the WHO recommendations on conducting Drug Utilisation Studies (DUS). Statistical Analysis-The collected data was numerically coded and entered in Microsoft Excel 2007 and analysed by SPSS version 16. Settings and Design-Prospective, cross-sectional, observational study. RESULTS Out of 612 patients, 262 (42.81%) were in the age group of 60 and above. Considering gender distribution, 328 (53.59%) were males and 284 (46.41%) were females. Of these, 274 (44.78%) were prescribed monotherapy, 256 (41.83%) were prescribed two-drug therapy, 72 (11.76%) were prescribed three-drug therapy and 10 (1.63%) were prescribed four-drug therapy. Among 274 (44.78%) patients prescribed with monotherapy, 112 (40.87%) were prescribed with CCB (calcium channel blocker), 76 (27.73%) were given BB (B-blocker), 45 (16.42%) were prescribed ACEI (angiotensin converting enzyme inhibitor), 35 (12.77%) were prescribed with ARB (angiotensin receptor blocker) and 6 (2.18%) were prescribed with Diuretics (D). Of the total antihypertensive drugs prescribed, 68.30% were prescribed by generic name, while 25.98% were prescribed as FDCs (fixed drug combination) and 39.05% of antihypertensive drugs were from NLEM (national list of essential medicine). Average number of drugs prescribed per encounter in our study was 2.42, while number of antihypertensive drugs per encounter were 1.34. CONCLUSION The findings of our study suggest that majority of prescriptions had generic names of the drugs. Improving practitioners' knowledge and attitude in rational prescribing can prove to be a cornerstone in achieving rational use of antihypertensive drugs.
International Journal of Pharmacy and Pharmaceutical Sciences, 2016
Objective: To study the prescribing patterns of antihypertensive (AHT) drugs in hypertensive (HTN) patients and hypertension with diabetes mellitus (HTN with DM) patients in tertiary care hospital, to assess the rationality of prescribing patterns, to compare the hypertension management with Joint National Committee-7 guidelines (JNC-7). Methods: A prospective study was conducted over a period of 6 mo in the medicine department of Bharati Hospital and Research Centre, Pune. HTN and (HTN with DM patients. Who met the study criteria were enrolled in the study. The pattern of antihypertensive medications prescribed was studied and analyzed using Microsoft excel 2010 and Statistical. The rational prescribing pattern was assessed by using JNC 7 guidelines and World Health Organization (WHO) indicators. Results: Total of 60 patients included in this study, 43 (71.7 %) were HTN patients, and 17 (28.3 %) were HTN with DM patients. There were 29 (48.33 %) males and 31 (51.66 %) female patients were involved. 45 % of patients had pre-hypertension, 33.33 % had stage-1 hypertension, 8.4 % had stage-2 hypertension other 13.33 % patients are on Antihypertensive medications and whose Blood Pressure (BP) were normal according to JNC-7. In hypertensive 47.05 % patient had prescribed Calcium Channel Blockers (CCBs) as monotherapy along with 87.5 % Angiotensin Receptor Blockers (ARBs) with diuretics as combination therapy. In HTN with DM 46.15 % patients had prescribed Angiotensin Converting Enzymes (ACEs) as monotherapy along with 62.5 % CCBs with BBs were prescribed according to JNC-7. As per WHO indicators, average no. of medicines prescribed per prescription was 2.91 and all antihypertensive medicines in the study population were prescribed rationally. Conclusion: The present study represents the current prescribing trend for antihypertensive agents. It implies that. In hypertensive patients ARBs are the leading group of antihypertensive agents as monotherapy and ARBs with diuretics as a combination therapy according to JNC 7.
Pattern of drugs prescribed for treatment of hypertensive patients: Bangladesh
African Journal of Pharmacy and Pharmacology, 2016
The exponential increase in patients with hypertension puts an enormous burden on healthcare providers. To describe the trends in the prescription of antihypertensive medication in a tertiary care hospital, Bangladesh is the objective of the study. This is a hospital based descriptive cross sectional study conducted at the Medicine outpatient Department in Dhaka Medical College Hospital. Patients more than 20 years of age suffering from Hypertension were included in the study. Data was collected by interviewing using a semi-structured questionnaire and analysed by computer with the help of SPSS 16. A total hundred patients were included in the study and 61.6% patients were prescribed on single drug and 38.4% patients were prescribed on combined therapy. Among the prescriptions having single anti-hypertensive medication most commonly used drugs are Angiotensin Receptor Antagonist (37.3%), Calcium Channel Blocker (32.8%), and ACE Inhibitor (17.9%), Beta Blocker (6%), Alpha Blocker (3%), Thiazide and non-Thiazide Diuretics 1.5% each. Among the prescriptions having combined drug therapy Angiotensin Receptor Blocker along with Calcium Channel Blocker and Calcium Channel Blocker along with Beta Blocker were equally (28.1%) chosen by the physicians and use of Angiotensin Receptor Blocker along with Diuretics was 25%, ACE Inhibitor with Calcium Channel Blocker 3.1%, ACE Inhibitor with Diuretics 3.1%, Thiazide and Non Thiazide Diuretics was 3.1% and other drugs were used for 9.5%. Pattern of using antihypertensive medications varies according to presence of co-morbidities and duration but does not vary significantly between male and female patients.