Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm (original) (raw)
Related papers
2014
Background: Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardioand renovascular protection benefits. Objective: To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. Methods: A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. Results: Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p ˂ 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p ˂ 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). Conclusions: Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio-and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.
Ethnicity & disease, 2013
Marked changes have been made in the pharmacotherapy of hypertension over the years. In sub-Saharan Africa, hypertension pharmacotherapy is often thought to include only thiazide diuretics, beta blockers and centrally acting medications and, it is unclear if and how often calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used. To examine the anti-hypertensive prescription pattern in a tertiary health centre in Nigeria to determine how it conforms to current guidelines. 590 newly diagnosed hypertensive patients presenting at the Cardiology Unit of University of Abuja Teaching Hospital over a three-year period were studied. Calcium channel blockers were the most frequently prescribed anti-hypertensive medications (66.9% of all cases) and centrally acting medications were prescribed in only 5.01% of cases. Single-pill combination either alone or in combination with other antihypertensive medications were prescribed in 17.3% cases. ...
Drug Utilization Pattern of Antihypertensives in a Private Healthcare Setting in Enugu, Nigeria
Texila International Journal of Public Health, 2022
Hypertension is a public health challenge worldwide. Drug utilization study is a component of medical audit that monitors and evaluates prescribing practices and recommends necessary modifications. This study focused on the drug utilization pattern of antihypertensive drugs. The study was a retrospective study of facility records on drug use among hypertensive patients. It was conducted in a private health care setting facility in Enugu. A total of 1,005 prescriptions were evaluated for drug prescribing patterns. The blood pressure control was evaluated. A combination of two drugs was frequently prescribed (42.3%). Drug prescribing pattern showed that Angiotensin receptor blocker (Losartan) was mostly frequently prescribed (38.94%). Drug utilization of antihypertensive drugs was in agreement with JNC 7&8 recommendations. In the study combination of two or more anti-hypertensive drugs was frequently prescribed. The blood pressure control among the population was greater than 90%.
Anti-hypertensive prescription pattern among general medical practitioners in Kano, Northern Nigeria
Background: General medical practitioners are responsible for providing care for most hypertensive patients in developing countries, including Nigeria. Concerns have been raised about the pattern of anti-hypertensive medications prescription in some countries. Most previous studies that have assessedphysicians' anti-hypertensive prescription patterns were carried out in tertiary care institutions. The aim of this study was to assess the anti-hypertensive prescription pattern of non-specialist general medical practitioners in Kano State, Northwestern Nigeria. Methods: This was a cross-sectional survey carried out among non-specialist general practitioners practicing within Kano State, Nigeria. A total of 138 doctors completed questionnaires about their demographics, duration and location of practice, and anti-hypertensive prescription patterns.Continuous variables were presented as mean ± standard deviation. Qualitative variables were expressed as proportions and percentages. Results: One hundred and fourteen (82.6%) doctors directly care for hypertensive patients routinely, with only 31 (22.5%) attending to less than 20 patients per month.Majority (47%) considered thiazide diuretics their first choice antihypertensive.Angiotensin converting enzyme inhibitors (ACEIs) were the commonest used drugs as single agent (55.7%) or in combination with other classes. The frequently used combinations were ACEIs/ thiazides (43.5%), ACEI/ Calcium channel blockers (CCBs) (24.6%) and CCBs/ thiazides (8.7%). The most frequently considered factors when prescribing antihypertensive medications were cost of the medications (84.7%), side effect profile of the medications (68.1%), presence of compelling indications and contraindications (57.2%), blood pressure at the time of presentation (56.2%) and the dosage frequency. Conclusion: The anti-hypertensive prescription pattern for the majority of the non-specialist general medical practitioners in Kano is in accordance with the current hypertension treatment guidelines.
Introduction: Hypertension has been reported as the strongest modifiable risk factor for cardiovascular morbidity and mortality. Aims: The aim of the study was to identify the most prescribed antihypertensive drugs, its patterns, comorbidities, cost of medications, and laboratory investigations. Settings and Design: This study was a cross-sectional, descriptive study of hypertensive patients conducted at the Lagos State University Teaching Hospital, Ikeja. Subjects and Methods: A total of 200 case notes were retrieved from the medical records unit over a period of 8 weeks. Information on antihypertensive prescriptions and comorbidities was retrieved. The average cost of medications and laboratory investigations was calculated. Statistical Analysis Tool Used: SPSS software version 16. Results: The mean age of the patients was 58.44 ± 12.65 years. Of the 200 patients, 5 (2.5%) were on monotherapy and 195 (97.5%) were on combination therapy. One hundred and twenty (60%) patients had comorbidities which included congestive heart failure 55 (27.5%), diabetes mellitus 22 (11%), hyperlipidemia 15 (7.5%), and cardiovascular disease 13 (6.5%). The various classes of antihypertensive drugs prescribed were diuretics 128 (64.0%), beta-blockers 126 (63.0%), calcium channel blockers 106 (53.0%), angiotensin-converting enzymes inhibitors 103 (51.5%), angiotensin receptor blockers 33 (16.5%), alpha blockers 9 (4.5%), and fixed drug combinations 2 (1.0%). The average cost per month of the antihypertensive medications was ₦ 2045 (US$10.2). Conclusions: Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure. Community-based insurance scheme should be encouraged and effective implementation of integrated noncommunicable diseases screening into the primary health care services would be helpful.
Hypertension is a cardiovascular disease with high morbidity and mortality. Effective blood pressure control can be achieved in patients with lifestyle modifications and by the use of antihypertensive agents. The objective of this study was to determine the prescribing pattern of antihypertensive medications in a tertiary health institution in SouthEastern Nigeria and also to determine the prescribers' compliance to recognised treatment guidelines. This was a retrospective cross sectional study and a total of 848 prescriptions generated from 202 hypertensive case files were used. Data extracted from the case files of hypertensive patients who attended the hospital from January to December, 2010 were coded and analysed using Statistical Package for Social Sciences (SPSS). The mean age of the patients consisting of mainly females (n=119, 59%) and then, males (n=83, 41%) was 59 years. Stage 2 hypertension was the most common class seen among the patients followed by stage 1 and then, the prehypertension with antihypertensive agents prescribed at all the stages. Co-morbid conditions increased with increase in blood pressure with type 2 diabetes being the most common, followed by congestive heart failure (CHF). The study also showed that the two most commonly prescribed agents either as monotherapy or as combination therapy were diuretics (D) and calcium channel blockers (CCBs) followed by angiotensin converting enzyme inhibitors (ACEIs) with angiotensin receptor blockers (ARBs) being the least prescribed. This study showed that there were reductions in the mean systolic and diastolic blood pressures with a decrease in mean arterial pressure (MAP) from 118 to 104 mmHg after initiation of therapy. This study shows a good adherence to current evidence based treatment guidelines and hypertension treatment guidelines.
American Journal of Internal Medicine, 2014
Background: Hypertension is a major public health concern globally and is associated with high morbidity and mortality in sub-Saharan Africa. Although antihypertensive therapy is effective in lowering blood pressure, a large proportion of patients do not have optimal blood pressure control. Aims: To describe the prescribing pattern and utilization of antihypertensive drugs and assess blood pressure control in a rural reference tertiary hospital in Nigeria. Methods: We conducted a cross-sectional study of 212 adult patients with hypertension attending the cardiology clinic of the Federal Medical Centre, Ido-Ekiti, Nigeria, between February 2012 and July 2012. Anthropometric, clinical and therapeutic data were collected using a pre-tested pro forma. Data analysis was done using SPSS 16.0 software (IBM, Chicago, Il, US). P value < 0.05 (two-sided test) was considered to be statistically significant. Results: We study 212 adults with hypertension, 48.1% of whom were male and the male-to-female ratio was 0.9. The mean age (± SD) of the patients was 61.5±15.1 years. Thirty two (15.1%), 95 (44.8%), 67 (31.6%) and 18 (8.5%) patients were on mono-, dual-, triple-and quadruple therapy respectively. Diuretics (84.9%) and calcium channel blockers (56.6%) were the most frequently used antihypertensive drugs. Blood pressure was controlled in only 45.3% of patients. Dual-and triple-therapy produced more patients with controlled blood pressure (dual-therapy, p=0.30; triple-therapy, p=0.11). Conclusions: Our study showed that diuretics were the most frequently prescribed class of antihypertensive drugs in our rural tertiary hospital as in many studies from urban centres in Nigeria and sub-Saharan Africa. Consistent with the global trend, the rate of controlled blood pressure among hypertensive patients was low, with combination therapy achieving control in more patients.
RADS Journal of Pharmacy and Pharmaceutical Sciences
Background: Access to essential medicines through health insurance contributes substantially towards achieving hypertension control in hypertensive sub-population of a nation. Objectives: This study aimed to estimate the gender-based antihypertensive medicines use, to describe utilization patterns, and to estimate prescribing adherence to the health insurance guideline. Methods: A descriptive, cross-sectional, retrospective review of paper-based prescriptions with at least an antihypertensive medicine written for insured outpatients from 1st January – 31st December 2013 at a Nigerian Federal Teaching Hospital was conducted. The prescription volume and Anatomic Therapeutic Chemical/Defined Daily Dose (DDD) methodology was used to estimate the extent of utilization of antihypertensive medicines among the study population. Drug utilization ninety percent (DU90%) was used to quantify the index of adherence to the National Health Insurance Scheme (NHIS) guideline. Differences in proporti...