Utilization Study of Antihypertensives in a South Indian Tertiary Care Teaching Hospital and Adherence to Standard Treatment Guidelines

Abstract

Aim:Hypertension represents a major health problem primarily because of its role in contributing to the initiation and progression of major cardiovascular diseases. Concerns pertaining to hypertension and its sequelae can be substantially addressed and consequent burden of disease reduced by early detection and appropriate therapy of elevated blood pressure. This cross-sectional observational study aims at analyzing the utilization pattern of antihypertensives used for the treatment of hypertension at a tertiary care hospital in perspective of standard treatment guidelines.Materials and Methods:Prescriptions were screened for antihypertensives at the medicine outpatient department of a tertiary care teaching hospital. Medical records of the patients were scrutinized after which 286 prescriptions of patients suffering from hypertension were included. The collected data were sorted and analyzed on the basis of demographic characteristics and comorbidities.Results:The calcium channel blockers were the most frequently used antihypertensive class of drugs (72.3%). Amlodipine (55.6%) was the single most frequently prescribed antihypertensive agent. The utilization of thiazide diuretics was 9%. Adherence to the National List of Essential Medicines (NLEMs) was 65%. The combination therapy was used more frequently (51.5%) than monotherapy (48.8%). The use of angiotensin-converting enzyme inhibitors/angiotensin 2 receptor blockers (ACE-I/ARB) was 41.4% in diabetes.Conclusions:The treatment pattern, in general, conformed to standard treatment guidelines. Few areas, however, need to be addressed such as the underutilization of thiazide diuretics, need for more awareness of drugs from the NLEMs and enhanced use of ACE-I/ARB in diabetic hypertensives.

Prescription Pattern of Cardiovascular and/or Antidiabetic Drugs in Abuja District Hospitals

“…The average number of CV drugs per prescription was 2.0, similar in both gender and close to previous reports on antihypertensive drugs in Nigeria 2.25 [16], 2 [30]. In contrast, a lower value was reported in South India at 1.78 [12]. The average number of diabetic drug per prescription was 1.7, also similar in both gender and consistent with the report of a previous study on anti-diabetic prescription in Southern Nigeria [20].…”

“…There was a high prescription of CCB, particularly amlodipine in FCT district hospitals. This was reported in some other studies [11,12,39,40] while CCB has been reported as least prescribed [22,41]. Agents that act on the renin-angiotensin system hold a good share of the prescription, with Lisinopril and Telmisartan leading in the class similar to other studies [15,41].…”

“…6% [21] and India 55.48% [11]. However, other studies reported a higher treatment rate in men [12,22]. Our report might relate to the recent report of the high prevalence of hypertension and obesity among women in Nigeria [23].…”

“…Considering gender difference in the use of CVD drugs, the use of CCB, ACEI/ARB and diuretics were significantly higher in women, which is similar to a US [48] report. However, another study [12] reported no significant difference in genders in the use of CVD drugs. Thiazide diuretic has been reported to adversely affect men sexually [27], which might contribute to its low prescription in men.…”

“…There are variations in the reports of prescription patterns for CVDs and diabetes drugs, studies have reported Calcium Channel Blockers (CCB) [11][12][13] or Angiotensin-Converting Enzyme Inhibitor (ACEI) [14,15] as the most utilized class of antihypertensive drugs. Other studies have documented diuretics [16,17] as the most utilized CVD.…”