PRESCRIPTION ? years of hypertensive with or without

PRESCRIPTION PATTERN OF ANTI –HYPERTENSIVE DRUGS AMONGHYPERTENSIVE PATIENTS AT DISTRICT HOSPITALK. DEEPAK MAHARSHI1*, T. VANI1, M.

NAVANEETHA1, G. JYOTHI1, SHANTVEER HALCHER2, GURURAJ V WADAGERI31 Pharm. D. (Doctor of Pharmacy), RGUHS, Bangalore, Karnataka, India.

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2 Department of Pharmacy Practice, RMES’s college of Pharmacy, Gulbarga, Karnataka, India.3 Department of Pharmaceutics, RMES’s college of Pharmacy, Gulbarga, Karnataka, India.*Corresponding authorEmail id: [email protected] TYPE: Research ArticleABSTRACT:BACKGROUND: To conduct a prospective observational study on prescribing pattern of anti-hypertensive drug in the department of GENERAL MEDICINE in Government District hospital, Gulbarga. In this study it was aimed to evaluate the current practice of anti-hypertensive drug by comparing with JNC-8 guidelines in population. OBJECTIVES: The objective of our study is to determine the prescription pattern of antihypertensive drugs and adherence to JNC8 guidelines and to find out the most prescribed anti-hypertensive drugs.

Methods: A Prospective Observational Study of 06 months was conducted. Undertaken 174 patients data collection form of all the patients of inpatient department of age 18 ? years of hypertensive with or without co-morbidities. Result: The results of this analysis suggests that out of the total 174 hypertensive patients included in the study, 92 patients were males while 82 patients were females, indicating the higher prevalence of hypertension in male population than in female population, that is 10% higher prevalence in males than in females. Out of the total study subjects, 169 hypertensive patients were found to have other co morbid conditions.

Considering out of the total 174 patients, majority of the patients received monotherapy (129) while remaining patients receiving the Combinational therapy are 45. However in the case of overall utilization pattern of antihypertensive agents, CCBs are the most frequently prescribed class of drugs, followed by ARBs , BBs and finally ACEIs .KEYWORDS: ACEI, ARB, BB, CCB, DM, HTN. INTRODUCTION: Hypertension is the major health problem and the expenses of its treatment are high. In the united states, approximately 50 million people have been diagnosed with hypertension, and half of them are treated with anti-hypertensive medication. In the early 1980’s calcium antagonist and angiotensin converting enzyme inhibitors gained ground as the first line anti-hypertensive drugs.

1 Antihypertensive pharmacotherapy effectively reduces hypertension-related morbidity and mortality. Appropriate pharmacotherapy for uncomplicated hypertension assumes paramount importance to public health because _70% of US hypertensive adults lack co-morbidities that compel the use of certain antihypertensive drug. 2 Most patients with hypertension require two or more antihypertensive medications. Thiazide diuretics, ?-blockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers and calcium channel blockers have all been shown to reduce complications of hypertension and may be used for initial drug therapy. In 2002, a clinical trial comparing different classes of antihypertensive medications for initial therapy found that chlorthalidone, a thiazide diuretic, was as effective as other agents in reducing coronary heart disease, death and non fatal myocardial infarction. The drug was superior to amlodipine in preventing heart failure and to lisinopril in preventing stroke. Selection of antihypertensive agents should therefore be based primarily on the comparative ability to prevent these complications. 3 More than 50% of treated hypertensive patients have a blood pressure level greater than 140/90 mm Hg (uncontrolled hypertension).

Several factors including, among others, poor adherence to therapeutic regimen, ignorance, and poverty have been adduced for the high prevalence of uncontrolled hypertension. Recent reports have however focused on the role of health care provider to poor adherence to antihypertensive drugs. Consequently, compliance with standard guidelines aiding physicians in effective prescription of antihypertensive drugs have been emphasized.

This study is aimed at determining the physician’s prescription pattern of antihypertensive medications in a tertiary health institution in north western Nigeria. Physician’s compliance with the existing guidelines is described. 4 The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is the largest randomized trial ever conducted to compare antihypertensive medications. Sponsored by the US National, Heart, Lung, and Blood Institute in conjunction with the US Department of Veteran’s Affairs, ALLHAT was designed to compare the efficacy of 4 types of antihypertensive medications – chlorthalidone (a thiazide-type diuretic), amlodipine (a calcium channel blocker CCB), lisinopril (an angiontensin-converting enzyme ACE inhibitor) and doxazosin (an ?-adrenergic blocker) – for reduction of risk of coronary heart disease (CHD) or other cardiovascular events .5 The seventh report of the joint national committee on the detection evaluation and treatment of high blood pressure (JNC 7) is the most prominent evidence based clinical guideline for the management of the hypertension.

6JNC 8 Guidelines 7:Hypertension is one of the most important preventable contributors to disease and death in the United States, leading to myocardial infarction, stroke, and renal failure when it is not detected early and treated appropriately. The Eighth Joint National Committee (JNC 8) recently released evidence-based recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults. In the general population of adults 60 years and older, pharmacologic treatment should be initiated when the systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. Patients should be treated to a target systolic pressure of less than 150 mm Hg and a target diastolic pressure of less than 90 mm Hg. Treatment does not need to be adjusted if it results in a systolic pressure lower than 140 mm Hg, as long as it is not associated with adverse effects on health or quality of life.In the general population younger than 60 years, pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg.

AIM & OBJECTIVE:To determine the prescribing pattern of anti- hypertensive drugs in the department of general medicine & to find out the most prescribed anti-hypertensive drugs.METHODOLOGY:A prospective observational study involving 174 patients carried out at Department of GENERAL MEDICINE, Gulbarga dist hospital, for the period of 6 Months (October 2016 to March 2017) Patients The data is collected from all the patients of either sex with primary and secondary hypertension in medicine inpatient department and who are willing to participate in the study, & not from the Patient below the age of 18 years, pregnant women and patients who are not willing to participate in the study. Patient data relevant to the study will be obtained from Case-sheets, medication chart & laboratory reports. RESULT:DEMOGRAPHIC PROFILE OF PATIENTS: Table 1In our study Involving 174 patients in total, 92 patients are male and 82 patients are female (Table 1)SL.

NO GENDER NUMBER1 Males 922 Females 82 FIG NO 1: DEMOGRAPHIC PROFILE OF PATIENTSAGE IN YEARS COLLECTED : TABLE NO .2SL.NO AGE IN YEARS NO.OF PATIENTS1 40-50 YEARS 132 50-60 YEARS 653 60-70 YEARS 704 70-80 YEARS 215 80-90 YEARS 05 FIG NO 2: AGE IN YEARS COLLECTEDSOCIAL HISTORY FACTOR IN MALES:TABLE NO.3SL.NO NO OF PATIENTS SMOKER ALCOHOLIC SMOKER &ALCOHOLIC NON SMOKER& ALCOHOLIC1 92 11 09 53 19 FIG NO 3: SOCIAL HISTORY IN MALESMONOTHERAPY USED IN HYPERTENSIVE PATIENTS: TABLE NO.4SL.

NO DRUGS PRESCRIBED NO OF PATIENTS1 AMLODIPNE 812 ATENOLOL 113 TELMISARTAN 174 RAMIPRIL 115 LOSARTAN 036 NICRADIPINE 017 ENALAPRIL 018 NEFIDIPINE 04 FIG NO 4: MONOTHERAPY USED IN HYPERTENSIVE PATIENTSCOMBINATIONAL THERAPY USED IN HYPERTENSIVE PATIETS: TABLE NO:5SL.NO DRUGS PRESCRIBED NO OF PATIENTS1 NEFIDEPIN+AMLODIPINE 062 AMLODIPINE+TELMISARTAN 143 AMLODIPINE+ATENOLOL 104 AMLODIPINE+NITROGLYCERINE 055 AMLODIPINE+RAMIPRIL 016 AMLODIPINE+LOSARTAN 017 ATENOLOL+NITROGLYCERINE 018 LOSARTAN+TELMISARTAN 019 TELMISARTAN+NITROGLYCERINE 01FIG.NO 5: COMBINATIONAL THERAPY USED IN HYPERTENSIVE PATIENTSCOMBINATIONAL THERAPY PRESCRIBED FOR HYPERTENSIVE PATIENTS: TABLE NO.

6 SLNO DRUGS PRESCRIBED NO OF PATIENTS10 AMLODIPINE+ATENOLOL+TELMISARTAN+NITROGLYCERINE 0111 LOSRATAN+AMLODIPINE+NITROGLYCERIN 0112 TELMA+NITROGLYCERIN+AMLODIPINE 0113 NITROGLYCERINE+ NEFIDEPIN+AMLODIPINE 01 FIG NO:6 COMBINATIONAL THERAPY USED IN HYPERTENSIVE PATIENTSHYPERTENSION WITH OTHER COMORBID DISEASES TABLE NO:7SL.NO HTN WITH OTHER COMORBID DISEASES NO OF PATIENTS1 DM ,HTN & CVA 022 CVA , HTN 103 HTN ,DM & LVF 034 AGN ,ASTHMA ,HTN 015 BRONCHIAL ASTHMA , HTN 126 CVA &ASPIRATION PNEUMONIA & HTN 017 ACCELERATED HTN 118 HTN WITH ACUTE GE 019 ACCELERATED HTN & CCF 0210 HTN WITH ANEMIA 0711 DM WITH HTN 2012 ACUTE GE & HTN & DM & MILD DEHYDRATION 0113 COPD WITH HTN 0614 ACUTE BRONCHITIS, HYPOTHYROIDISM&HTN 02 FIG NO :7 HTN WITH OTHER COMORBID DISEASESHTN WITH OTHER COMORBID DISEASES TABLE NO:815 HTN,LRTI 0216 HTN,CKD,ANEMIA 0317 HTN,DM,CKD 0118 HTN,COPD,CORPULMONALE 0419 HTN,COPD,CORPULMONALE ,PTB 0320 HTN,COPD, HEMOPTYSIS 0421 ACCELERATED HTN,ANEMIA 0222 HTN,ANEMIA,PNEUMONIA 0223 HTN,CVA,DM,ANGINA 0324 HTN,CVA,HEMIPARESIS,LRTI 0125 HTN,CVA,ASTMA 0126 HTN,CVA,SEIZURE DISORDER 0327 HTN,SEIZURE DISORDER 01 FIG NO: 8 HTN WITH OTHER COMORBID DISEASESDISCUSSION:The results of this analysis suggests that out of the total 174 hypertensive patients included in the study, 92 patients were males while 82 patients were females, indicating the higher prevalence of hypertension in male population than in female population, that is 10% higher prevalence in males than in females.The highest number of hypertensive patients 70 belonged to the age group of 60-70 years and then belonged to the age group of 50-60 years 65 patients , 70-80 age group 21 patients then 13 patients were belonging to the age group of 40-50 years, then 5 members were belonging to the age group of 80-90 years. Out of the total study subjects174, 11 hypertensive patients were not found to have other co morbid conditions, Remaining 163 Patients were found to be comorbid like DM (20), Bronchial asthma(12), CVA(10) , Anemia (7), COPD (6), corpulmonale (4) etc. Considering out of the total 174 patients, majority of patients received monotherapy (129) while combinational therapy were received by the patients( 45) . Among the monotherapy category the various hypertensive classes prescribed were ranked as follows CCB’s (81) followed by ARB’s like telmisartan (17) and ACE inhibitors like Ramipril (11) etc.

As a monotherapy Amlodipine (15%) was the most frequently prescribed drug as monotherapy along with telmisartan and losartan and ramipril . In the overall utilization pattern of antihypertensive agents, CCB’s and Diuretics ARBS were the most frequently prescribed class of drugs, followed by ACEI’s , and finally BB blockers. CONCLUSION:Hypertension is more seen in male patients compared to female patients. Most of the patients were in the age group of 60-70 years and above constituting 96.7% of total patients.

Prescription Pattern Varies with age, gender and other complications associated with hypertension. Physician need to maintain a vital therapy for the successful treatment of hypertensive patients. A Pharmacist job is to monitor all the interventions like physician analysis, Drug intercations etc. Prescription pattern of the present study concluded amlodipine was the most commonly prescribed anti – hypertensive drug in the monotherapy followed by Telmisartan. Most of the combinational therapy prescribed in hypertensive patients were amlopdipine + telmisartan. Anti-Anginal drug like Nitroglycerine are also used for complicated hypertension.

Drug used in hypertensive patients such as CCBs like amlodopine, Nefidipine, Nicardipine & ARBs like Telmisartan. Losartan & ? Adreneric blockers like Atenolol & ACE inhibitors like Ramipril were the most commom drugs used for uncomplicated patients. Therapeutic Regimen depends on age, young hypertensive were compared with older age groups were substantially were less aggressively treated mostly with monotherapy. Treatment was increased when concomitant comorbid disease were present.Finally the overall findings of the study show that there is a further improvement in the prescription pattern of anti-hypertensives.CONFLICTS OF INTEREST:NoneACKNOWLEDGMENT:Authors thank Dr.

IJAZ AHMED KHAN for helping us in editing.REFERENCES:1. Chih-Chieh Chou1 Meei-Shynan Lee2 Ching-Hsing Ke1 Mieng-Hsian Chung , Prescription Pattern of Hypertension –National Health Insurance in Taiwan. J Chin Med Assoc:2004 ,67:123-130. 2.

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Rimoy , M. Justin-Temu And C. Nilay Prescribing Patterns and Cost of Antihypertensive Drugs in Private Hospitals in Dar es Salaam,Tanzania .

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Chika, J. Akuche and M. Ali Prescription Pattern Of Anti-Hypertensive Drugs In A Tertiary Health Institution In Nigeria. Annals Of African Medicine: 2008 ; 7(3):128-132. 5. Vittorio Maio, Joshua J. Gagne, Impact of ALLHAT Publication On Anti – hypertensive Prescribing Patterns in Regione Emilia-Romagna, Italy.

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Kuchake VG , Maheshwari Od , Surana SJ Patil PH , Dighore PN Prescription Pattern of Antihypertensive Drugs in Uncomplicated Hypertensive Patients at Teaching Hospital .Indian Journal of pharmarcy practise.April-June 2009;2(2).7. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in AdultsReport From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).

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