Antihypertensive Prescribing Pattern and Blood Pressure Control among hypertensive patients over a Ten Year period in a Primary Care Setting in Malaysia (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
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.
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.
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.
Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. Antihypertensive medications are a class of drugs that are used to treat hypertension. Recent studies have shown that prescribing practices of health providers for hypertension medication did not match the guidelines released by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC VII & VIII). Hence, approximately half of the hypertension and various comorbidities did not received from first-line treatments. A prospective cross-sectional study was conducted. Data was coded and entered into the Statistical Package for Social Science (SPSS) version 19 for Windows. A 5% sample pretest was performed on randomly selected patients before the beginning of the study. A total of 288 participants were recruited and studied. More than half of the participant patients were female 164 (56.9%) and that of male were 124 (43.1%). Among the study participants 166 (58%) were prescribed with monotherapy and the rest 122(42%) were received combination of medications. More than fifty percent of the participants were diagnosed to have HTN only; a total of 124(43.1%) patients had one or more concurrent diseases. patients with age in between 50 and 59 (p=0.032) were almost 16 times more prone to develop poor BP control [95% C.I (2.6-97.6)] compared to the other age groups. The single most common risk factor for poor BP control in our study was positive family history [(p=0.02) and 95% C.I (2.9-110)]. Patients who have positive family history of blood pressure had almost 18 times prone to develop poor blood pressure control compared to other studied risk factors like (use of high fatty diet, smoking and Diabetes Mellitus). The major determinants that contributed for poor blood pressure control were age greater than 50, BMI greater than 24.9, family history and the presence of other comorbidities. Females were affected more than males by hypertension in the study area and this result was consistent with a number of similar studies.
Cureus
Background Hypertension is the leading risk factor for cardiovascular disease and death. Appropriate treatment of hypertension is necessary to reduce mortality. A prescription-based study is one of the most influential and helpful methods to examine physicians' irrational prescribing practices. This study was designed to investigate the antihypertensive prescription of physicians and their adherence to the treatment guidelines, as well as the blood pressure (BP) control rate in a general hospital in the Kingdom of Saudi Arabia. Methodology A retrospective, cross-sectional study was conducted between February 2020 and June 2021 in an outpatient department. Patients diagnosed with hypertension as per the 2020 International Society of Hypertension guidelines and those who received antihypertensive drugs were included. Study data included prescriptions, patient's age, duration of hypertension, comorbidities, BP, drug therapy type, and antihypertensive class. Results Overall, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (67.1%) were the most prescribed agents, followed by dihydropyridine-calcium channel blockers (62.6%), diuretics (26.1%), and βblockers (10.1%). Comorbid and stage 2 hypertensive patients mainly received combination therapy (51.6%) rather than monotherapy (48.4%). The study revealed an 83.5% prescription adherence to the treatment guidelines. However, non-adherence was encountered in monotherapy, polytherapy, and elderly-treated patient groups. A 66.4% (at target BP in all cases <140/90 mmHg) and 39.3% (at target BP in comorbid patients <130/80 mmHg) rate of BP control was observed. Furthermore, the rate of BP control was significantly associated with prescription adherence (χ 2 = 71.316; p < 0.001). Conclusions The degree of prescription adherence and rate of BP control were found to be compatible with other published hypertension studies. However, considerable scope exists for improvement in rational drug utilization and rate of BP control, particularly in high-risk patients. Therefore, treatment guidelines must be followed by clinicians to achieve BP goals and reduce cardiovascular events among the Saudi population.
Study on Prescribing Pattern of Antihypertensive Drugs in a Tertiary Care Hospital
Advances in Pharmacology and Pharmacy, 2017
Objective: To analyze prescription pattern of antihypertensive drugs in patients with hypertension alone and with coexisting diseases. Methodology: A descriptive cross-sectional study was conducted in outpatient department of tertiary care hospital in south India. A total of 286 prescriptions of patients diagnosed to have hypertension with or without coexisting diseases were collected. Details of prescriptions were entered in the preformed pro forma and analyzed. Result: The study included 138 (48.25%) male and 148 (51.75%) female. Out of 286 hypertensives, 122 (42.66%) patients were having co-existing type 2 diabetes mellitus (T2DM). And remaining 164 patients (57.34%) were only hypertensives. Out of 286 patients, 227 (79.31%) patients were on monotherapy, 49 (17.13%) were on dual therapy and remaining 10 patients were on triple anti-hypertensive drugs. Among 150 antihypertensive drugs that are prescribed for hypertensive patients withT2DM, 57 (38%) were calcium channel blocker (CCB), 40 (26.66%) were angiotensin converting enzyme inhibitors (ACEI), 31 (20.66%) were angiotensin receptor blockers (ARB), 13 (8.66%) were diuretics and remaining 9 (6%) were beta blockers. Similarly, among 206 antihypertensive drugs prescribed for hypertension alone patients, 97 (47%) were CCB, 37 (17.96%) were ACEI, 31 (15%) were ARB, 26 (12.62%) were diuretics and remaining 15 (7.28%) were beta blockers. Conclusion: The study has shown that majority of patients were on monotherapy (79.31%) and calcium channel blockers were commonly prescribed for hypertension in patients with or without type 2 diabetes mellitus followed by ACE inhibitors, ARB and beta blockers.
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.
International Journal of Pharmacy and Pharmaceutical Sciences, 2016
The aim of the study is to assess the various prescribing patterns in hypertension with different compelling indications. Methods: It is a prospective observational study and carried out for a period of 1 y from Feb-2014 to Feb-2015. All the required data was collected from patients through personal interview and prescriptions. The data collected from the participants was entered into Microsoft excel spreadsheet and descriptive statistics were used. The mean and standard deviation (SD) were calculated. Results: A total of 394 hypertensive patients with different comorbidities were included in which 251(63.70%) males and 143(36.29%) females were present with a mean (SD) age of 59.21±1.54. The most commonly reported first three co-morbidities along with hypertension were diabetes mellitus 191 (48.47%), stroke accounts for 57 (14.46%) and coronary artery disease in 32 (8.12%). Monotherapy was given in almost 200 (50.76%) patients and dual drug therapy was indicated in 166 (42.13%) patients, triple therapy was used only in 24 (6.09%) patients in the total sample size. Quadruple therapy is the least preferred combination therapy accounts only in 4 (1.01%) patients. Conclusion: We conclude that calcium channel blockers and angiotensin II receptor blockers were the most commonly prescribed class of drugs either alone or in combination with other class of drugs for effective control of blood pressure patients with different compelling indications. Monotherapy was preferred than combination therapy.