A Cross Sectional Observational Study Evalating Perspectives and Therapeutic Options Amongst Clinicians in Young Indian Hypertensives

Abstract

Objective: Hypertension has been reported in 12.1% of young adults in a recent population-based study in India and is a growing concern. There is a paucity in guidelines on the definite therapeutic approach in young hypertensives. This study aimed to understand the clinician's perspective on approach to management of hypertension in young adults in India. Design and method: Cross-sectional observational survey conducted between February 6, 2020 and 22 February 22, 2020 using a structured 14-item questionnaire. Total of 2287 clinicians (cardiologists, diabetologists, consultant physicians, and family physicians) across India participated in this survey. Descriptive statistics were first computed. Inferential statistics, namely chi-square test was then run to test the associations among knowledge, awareness and practice among the respondents across India. Results: Prevalence of hypertension in young adults was observed in 10–30% by 64.8% participant clinicians. Smoking, mental stress and obesity were considered as the most common risk factors for hypertension in young adults. Parameters of sympathetic overactivity in young hypertensive patients were considered as only increased systolic blood pressure, only increased heart rate and both increased heart rate and increased systolic blood pressure by 15.1%, 24.2% and 57.4% of respondents respectively. Angiotensin II receptor blockers (ARBs) were considered the most appropriate class of drugs to treat hypertension in young by 61.6% respondents. Beta-blockers were preferred by 15.8%, followed by calcium channel blockers, diuretics and ACEI by 10.4%, 7.6% and 4.6% respondents respectively. Beta-blockers were selected as antihypertensive class in young hypertensive adults based on their perception of sympathetic overactivity by 74.5% respondents. Metoprolol was the preferred beta-blocker by 63.1% respondents. Combination therapy of telmisartan & metoprolol was preferred by 15.5%, 40.9%, 43.6% clinicians in young hypertension, uncontrolled hypertension, both young and uncontrolled hypertension patients respectively. Conclusions: This study adds to the real-world data in management strategies of young Indian hypertensives. Amongst the current class of anti-hypertensive drugs, ARBs and beta -blockers were preferred by the clinicians who participated in the study. Monotherapy and combination therapy with telmisaratan and metoprolol as a prototype of the respective anti-hypertensive class were preferred in the study.

Management of hypertensive patients with ischemic heart disease and the role of a fixed-dose combination of telmisartan and metoprolol: a physician-based research survey

“…Telmisartan and metoprolol single-pill combination achieved the blood pressure target in 40%-60% of patients as reported by 41.3% of the physicians. 14 The combination therapy was well tolerated in young hypertensive patients. Initiation of an early and appropriate antihypertensive treatment in young population may lower the burden of CVD in this population.…”

“…A cross-sectional, observational survey conducted by Jadhav et al revealed that amongst the ARBs, telmisartan was the preferred ARB by >80% respondents, and metoprolol was the preferred beta-blocker by almost 64% respondents. 14 Based on the rationale of sympathetic overactivity, most clinicians choose a β-blocker as part of antihypertensive prescription in hypertensive adults.…”

“…ARBs and beta-blockers were the preferred classes of antihypertensive drugs for young hypertensive patients. 14 Metoprolol is a cardioselective beta1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors. Metoprolol significantly lowers the heart rate.…”

“…Combination therapy has been proven to achieve blood pressure control in that more patients can reach target blood pressure faster. 14 A doseescalation approach using monotherapy reduces coronary events by 29% and cerebrovascular events by 40%, while combining two antihypertensive agents with a different mechanism of action reduces coronary events by 40% and cerebrovascular events by 54%. Hence, the use of combination therapy offers greater target organ protection than increasing the dose of monotherapy.…”

“…Hence, the use of combination therapy offers greater target organ protection than increasing the dose of monotherapy. 14 Cardiologists tend to prefer beta-blockers as initial antihypertensive therapy in the real-world setting, with metoprolol being the most commonly prescribed drug. 14 Similarly in our survey, approximately >90% of the participating cardiologists and consulting physicians prefer an FDC of a beta-blocker (metoprolol) and ARB (telmisartan) for the management of hypertension with IHD.…”