A review on prescribing patterns of antihypertensive drugs

Abstract

Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.

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Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation

“…We observed a 48% reduction in ACEi/ARB use in the post‐JNC‐8 era compared with the earlier period. This pattern contrasts with JNC‐8 recommendations for the general population and with observation that ACEi/ARB use has increased in general population . The difference may relate to specific considerations or concerns in KTx recipients.…”

“…As in the general population, CCB use appears to have increased in recent years . A study directly comparing ACEi to CCB use in KTx recipients showed similar safety and efficacy; however, CCBs were associated with improved GFR 2 years post‐transplant.…”

“…This pattern contrasts with JNC-8 recommendations for the general population and with observation that ACEi/ARB use has increased in general population. 18 The difference may relate to specific considerations or concerns in KTx recipients. In a systemic review of 21 trials (1549 KTx recipients), ACEi/ARB treatment was noted to significantly reduce proteinuria and GFR post-transplant, but data were insufficient to determine effects on hard outcomes such as patient or graft survival.…”