Drug Utilization Patterns of Anti Hypertensive Medication in a Tertiary Care Hospital

Abstract

BACKGROUND: Drug utilization study analyses the prescribing patterns and justifies the rational use of drugs. Clinicians often face challenges in selecting, initiating, and individualizing appropriate drug therapy for patients. Physicians' inability to provide good management of hypertension has been identified as an important contributor to poor BP control in hypertensive patients. We assessed the prescribing trends in hypertensive patients by various physicians. METHODS: Data for study was collected from Narayana Medical College and Hospital, Nellore during a period of 10 months from outpatient departments of General Medicine, Cardiology and Nephrology. 2440 hypertensive prescriptions were analyzed. Hypertension was defined as SBP/DBP greater than 140/90 or taking medications for hypertension irrespective of etiologies. RESULTS: Both essential and secondary hypertensive prescriptions were analyzed. The mean age of the participants was 51.95± 12.68 yrs. The mean SBP of the participants was 151.98±17.75 and DBP was 93.44±10.55 mm of Hg. We found that 1663 patients were essential hypertensive and 577 were hypertensives due to chronic kidney disease. CCB was the most commonly prescribed 961(42.90%), followed by beta blockers 882(39.38%), Angiotensin receptor blockers (ARB) 646 (28.8%), Angiotensin converting enzyme inhibitors (ACEI) 420(18.75%), diuretics 231(10.3%), clonidine 119(5.3%) and prazosin 96(4.29%). 767(34.2%) were receiving monotherapy, 977(43.6%) on two drugs, 390(17.4%) on three drugs, 88(3.9%) were on four drugs and 5(0.2%) on five drug combinations. 13 (0.60%) were not using any drugs. Only 704 (31.43%) were responders. Among the prescribed drugs, 93% of drugs were prescribed by trade name and 20.64% were fixed-drug combinations. Average number of drugs prescribed was 1.91±0.84. CONCLUSIONS: It was observed that majority of drugs were prescribed by brand names on an average two drugs per prescription. CCBs were the most commonly used drugs to treat hypertension among all the age group patient population followed beta blockers ARB, ACEI, Diuretics, Clonidine and Prazosin. It was also found that there was less number of fixed dose combinations. The study suggests that there is immense scope of improvement in prescribing practices in the form of rational drug prescribing for achieving optimal blood pressure control.