Frequency, preferences and prescribing pattern of antihypertensive drugs in Out-Patient Department of a tertiary care SGM Hospital, Rewa district of Madhya Pradesh, India.
Abstract
Aims and Objectives: The aim of study was to determine the frequency and prescribing pattern of antihypertensive drugs in Out Patient Department of a tertiary care hospital and to identify whether the pattern of prescribing is appropriate in accordance with national and international guidelines for pharmacotherapy of hypertension.
Methods: This was a prescription-based survey; the prescriptions were collected randomly from OPDs of SGM Hospital as xerox copies after taking the consent of the patients. A total of 3587 prescriptions were analysed.
Results: In the 3587 prescriptions a total 8144 drugs were prescribed; of these only 4.19% (342) drugs belonged to the cardiovascular group. Among the cardiovascular drugs 94.73% (324) belonged to antihypertensive and 5.26% were anti-CHF drugs. 91.35% drugs were prescribed as monotherapy and 8.64% as combination therapy. The Calcium channel blockers (CCBs) (Amlodipine 83.47%) were the most frequently prescribed antihypertensive drugs (35.49%) followed by Angiotensin-converting-enzyme inhibitors (ACEIs) 25% (Enalapril 60.49%), β-blockers 13.27% (Atenolol 69.76%), angiotensin (AT1) receptor antagonists or angiotensin receptor blockers (ARBs) 9.25% (Losartan 80.0%), combination therapy 8.64% (AT+AM / LO+HCTZ 46.42%) and diuretics 8.33% (Hydrochlorothiazide 55.55%). However over all prescribing frequency among antihypertensive drugs were as follows: Amlodipine (29.63%) ≥ Enalapril (15.12%) ≥ Ramipril (9.87%) ≥ Atenolol ≥ (9.25%) ≥ Losartan (7.40%) hydrochlorothiazide ≥ (4.63%) ≥ Es-amlodipine (4.32%) ≥ AT+AM (4.01%)= LO+HCTZ (4.01%) ≥ Frusemide (3.70%) ≥ Candesartan (1.85%) ≥ Metoprolol (1.54%) and others.
Conclusions: Most of antihypertensive drugs in this study were prescribed as monotherapy. Amlodipine was most frequently prescribed antihypertensive followed by Enalapril ≥ Ramipril ≥ Atenolol ≥ and Losartan, in combination therapy AT+AM and LO+HCTZ were equally prescribed. The pattern of this study was in accordance with the National and International guidelines.
Abbreviations: HTN: hypertension CHF: congestive heart failure, ACEIs: angiotensin converting enzyme inhibitor, ARBs: angiotensin receptor blockers, CCBs: calcium channel blockers, AT: atenolol, AM: amlodipine, LO: losartan, HCTZ: hydrochlorothiazide.
References
2. Ker J. Combination treatment for hypertension. SA Fam Pract. 2010; 52 (5): 417–421.
3. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular disease: part- I: general considerations, the epidemiologic transition, risk factor, and impact of urbanisation. Circulation. 2001; 104 (22): 2746-53.
4. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 2003. Accessed at; www.nhlbi.nih.gov/ guidelines/hypertension.
5. Carter BL. Highlights of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Am J Health Syst Pharm.
1998; 55:382.
6. James PA, Oparil S, Carter BL, Cushman WC, Dennison HC, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014; 311 (17):1809.
7. Isezuo SA, Omotoso ABO, Gaye A, Corrah T, Araoye MA. One year survival among sub-Saharan Africans with hypertensive heart failure. Trop Cardiol. 2000; 26: 57–60.
8. Cappuccio FP, Micah FB, Emmett L, et al. Prevalence, detection, management, and control of hypertension in Ashanti, West Africa. Hypertension. 2004; 43:1017–1022.
9. Jassim al Khaja KA, Sequeira RP, Wahab AW, Mathur VS. Antihypertensive drug prescription trends at the primary health care centres in Bahrain. Pharmacoepidemiol Drug Saf. 2001 May; 10 (3):219-27.
10. Cheng H. Prescribing pattern of antihypertensive drugs in a general hospital in central China. Int J Clin Pharm. 2011 Apr; 33 (2):215-20.
11. Anju Madhwar, Dharmender Gupta, Sujata Singh, N. A. Ansari. Study of drug uitlization pattern of antihypertensive drugs in hypertensive nephropathy in a tertiary care teaching hospital, bareilly, U.P. Indian. Journal of Pharmacy and Pharmacology. 2015; 2(1): 10-15.
12. Sheron Joseph, Neethu Varghese and Levin Thomas. A study on prescribing pattern of anti hypertensive medications in a tertiary care hospital in Malabar region. Scholars Research Library, Der Pharmacia Lettre. 2014; 6 (4):132-137.
13. Anand Kale, Yasmeen A. Maniyar. Prescribing Patterns of Antihypertensive Drugs in A Tertiary Care Hospital. Sch. Acad J Pharm. 2013; 2 (5):416-418.
14. YN Clement, S Ali, S Harripaulsingh, K Lacaille, O Mohammed, S Mohammed, T Ragbir, E Ramirez, K Tshiamo Drug Prescribing for Hypertension at Primary Healthcare Facilities in Trinidad. West Indian Med J. 2012; 61 (1): 43.
15. Olanrewaju TO, Aderibigbe A, Busari OA, Sanya EO. Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population. Int J Clin Pharmacol Ther. 2010; 48 (1):68-75.
16. Sandozi T, Emani VK. Survey of prescription pattern of antihypertensive drugs in hypertensives & hypertension associated diabetics. International Journal of Pharma and Bio Sciences. 2010;1(4)23-26.
17. Rekha MB, Rekha MS, and Purushotham Naidu. Assessment and Evaluation of Drug Information Needs of Physicians Treating Type-2 Diabetes Mellitus with Co- Existing Hypertension in a Tertiary Care Hospital Research & Reviews. Journal of Medical and Health Sciences. 2319- 9865.
18. Fedila Shukrala, Tesfaye Gabriel. Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Drug Design, Development and Therapy. 2015; 9: 519–523.
