Original Research Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm (original) (raw)
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Pharmacy Practice, 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.
Pharmacy practice, 2014
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 cardio- and renovascular protection benefits. To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. 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. Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertensi...
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.
Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Société canadienne des sciences pharmaceutiques, 2005
To evaluate physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria, determine the degree of usage of Angiotensin Converting Enzyme (ACE) inhibitor-based combinations and identify specific points of intervention to improve outcomes of anti-hypertensive combination therapy. A cross-sectional retrospective drug use review was conducted between June 1st and August 31st 2002 using randomly selected 200 case notes of patients attending the Hypertension Clinic at a 900-bed tertiary care facility in southwestern Nigeria. 11 case notes were not used due to incompleteness. 73% (138) of the patients were on anti-hypertensive drug combinations, comprising 71.7% (99), 24.4% (34) and 3.6% (5) on combinations of two, three and four drugs respectively. Overall, Thiazide diuretic consisting mainly of fixed dose combination of Amiloride and Hydorchlorothiazide (Moduretic(r)) was the most frequently prescribed drug class in anti-hypertensi...
Journal of Human Hypertension, 2003
The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and costeffectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A crosssectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61712 years (55% females), with a duration of treatment on a particular drug class or combination of 973 months. The initial blood pressure was 176720/108711 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), Po0.0001, and ACEinhibitors (ACEIs) (24%), Po0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (Po0.01) compared to the previous study. The fall in systolic blood pressure on D (r ¼ 0.65, Po0.001) or CCB (r ¼ 0.48, Po0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BPo140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs+D or methyldopa+thiazides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (Po0.01) equally by all treatments, with 95% confidence intervals ranging from À28 to À1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n ¼ 33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar ($) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI+D and 13.6 for methyldopa+thiazides. A combination of ACEI+CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BPo130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and costeffective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.
Drug Design, Development and Therapy, 2015
Background: Hypertension is a global concern and is one of the key preventable risk factors for cardiovascular events, resulting in unnecessary morbidity and mortality. The aim of this study was to assess the prescribing, dispensing and patient use pattern of antihypertensive drugs among patients attending Hiwot Fana Specialized University Hospital outpatient department. Methods: A hospital-based cross-sectional study was conducted in Hiwot Fana Specialized University Hospital on assessment of the prescribing, dispensing, and patient use pattern of antihypertensive drugs among patients who were above the age of 18 years and attending outpatient department from April 1-May 31, 2013. Data collection was conducted by reviewing the record of patients and direct observation of the dispensing process of randomly selected patients to measure average dispensing time, and direct interview with the patients. Results: A total of 400 patients met the inclusion criteria; out of the 400 patients studied, 63.5% were females. Most of the patients had Stage 1 hypertension (69%), followed by Stage 2 hypertension (31%). Out of the total number of patients, 264 were with different comorbid conditions: diabetes mellitus (64.3%), followed by congestive heart failure (15.1%) and ischemic heart disease (2.3%). The most frequently prescribed class of antihypertensive drugs was diuretics, of which hydrochlorothiazide was the most frequently prescribed drug, both in single (55%), followed by enalapril (22.3%), methyl dopa (11.2%), atenolol (6.9%), and nifedipine (4.6%), and in combination with other antihypertensive drugs. The average dispensing time was 1.2 minutes, and 75% of the patients left the counter with inadequate information about the dosage. Conclusion: All antihypertensive drugs prescribed were in compliance with the Ethiopian Standard Treatment Guidelines. This study showed that most outpatients with hypertension in our hospital received monotherapy. Diuretics and angiotensin converting enzyme inhibitors were the most frequently prescribed classes of antihypertensive drugs in both monotherapy and combination therapy.
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.
PRESCRIPTION PATTERN OF ANTIHYPERTENSIVE DRUGS IN A TERTIARY HEALTH INSTITUTION IN NIGERIA
Objective: This study examined the pattern of physicians' prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians' compliance with recommended guidelines. Methods: Records of 145 patients aged 17-91 (mean: 52.6 ± 14.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and 90mmHg, respectively. Results: Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and 4 drugs, respectively. Diuretic was the most frequently prescribed drug either as a single agent (44.8%) or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were more in patients on calcium channel blocker than those on diuretic monotherapy (t = 2.5 and 3.6 for reductions in systolic and diastolic BP, respectively; P < .05 for both), and, in patients on combination therapy than those on monotherapy (t = 3.64 and 3.27 for reductions in systolic and diastolic BP, respectively; P < .01 for both). Blood pressure control rate was 30.5%. Conclusion: Our results are consistent with the previously observed benefits of antihypertensive combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major limitations of this work include its retrospective nature and the inability to determine the actual patients' adherence to therapy.
Journal of Clinical & Experimental Research, 2013
Background: Hypertension is one of the leading causes of cardiovascular disease. Though many clinical guidelines published recently for the treatment of hypertension, there is substantial variation in the treatment of hypertension in different countries. Aims and objectives: To evaluate the drug utilization pattern among hypertensive patients and their adverse effects attending medicine OPD in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted by Department of Pharmacology in a tertiary care teaching hospital over a period of six months. The diagnosis and line of treatment to be given was decided by the physician in charge of the Department of Medicine. All the information of ADR was recorded in CDSCO Suspected ADR reporting form. Results: Out of 600 patients, 43.83% were male and 56.17% were female. Maximum patients belonged to age group of 51-60 years (33.5%). Diabetes mellitus (40.33%) was the most common associated disease with hypertension. About half of the patients had received two antihypertensive drugs (49.50%), followed by one (33.16%) and three (15.5%) antihypertensive drugs. Enalapril was the most commonly prescribed antihypertensive drug (79.66%). 95 patients (15.83%) from the total of 600 patients developed ADR. Most common ADR was cough (18.94%) followed by headache (12.63%) and vomiting (10.52%). Enalapril was responsible for about half of the ADR (50.52%) followed by amlodipine (25.26%) and furosemide (25.26%). Conclusion: Rational utilization pattern of antihypertensive drugs was observed. However diuretics and calcium channel blockers prescribed less commonly. Most of the ADRs were probable (55.79%) and mild (30.53%).
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%.