Prescription patterns of antihypertensive drugs in a tertiary care hospital in India

Ashok K. Sharma, Navdeep Dahiya, Jayant K. Kairi, Sandesh M. Bharati

Abstract


Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India.

Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with co-morbidities were excluded from study. The data were analyzed to find out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency.

Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensin-converting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed.

Conclusions: This study represents the current prescribing patterns for anti-hypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.


Keywords


Prescription patterns, Prescription monitoring, Antihypertensive drugs, Drug utilization

Full Text:

PDF

References


Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52.

Kochen TA. Hypertensive vascular disease. In: Fauci AS, Braunwal EB, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 17th Edition. New York: The McGraw-Hill Companies Inc.; 2008: 1549-62.

Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens 2004;18:73-8.

Sutters M. Systemic hypertension. In: McPhee SJ, Papadakis MA, Rabow MW, editors. Current Medical diagnosis and treatment. 50th Edition. USA: McGraw Hill Lange; 2011: 416-45.

Pradeepa R, Mohan V. Hypertension & pre-hypertension in developing countries Indian J Med Res. 2008; 128:688-90.

Rang HP, Dale MM, Ritter JM, Flower RJ, editors. The vascular system. In: Rang and Dale’s Pharmacology. 6th Edition. UK: Churchill Livingstone; 2007: 298-320.

Pai PG, Shenoy J, Sanji N. Prescribing patterns of antihypertensive drugs in a South Indian tertiary care hospital. Drug Invent Today. 2011;3(4):38-40.

Gupta N, Sharma D, Garg SK, Bhargava VK. Auditing of prescriptions to study utilization of antimicrobials in tertiary hospital. Indian J Pharmacol. 1997;29:411-5.

Tiwari H, Kumar A, Kulkarni SK. Prescription monitoring of anti-hypertensive drug utilisation at the Panjab University Health Centre in India. Singapore Med J. 2004;45(3):117-20.

Shah S, Anand P, Maiya M, Mukherjee S, Munjal YP, Wander GS, et al. Indian hypertension guideline 2007. In: Munjal YP, editor. Postgraduate Medicine (Recent Advances in Medicine). Volume 21. New Delhi: The Association of Physicians of India and Indian College of Physicians, Ajanta Offset and Packaging Ltd.; 2007: 315-25.

National Clinical Guideline Centre (UK). Hypertension: the Clinical Management of Primary Hypertension in Adults: update of Clinical Guidelines 18 and 34. (NICE Clinical Guidelines, No. 127.). London: Royal College of Physicians (UK); 2011.

Ubel PA, Jepson C, Asch DA. Misperceptions about beta-blockers and diuretics: a national survey of primary care physicians. J Gen Intern Med. 2003;18(12):977-83.

Rochefort CM, Morlec J, Tamblyn RM. What differentiates primary care physicians who predominantly prescribe diuretics for treating mild to moderate hypertension from those who do not? A comparative qualitative study. BMC Fam Pract. 2012;13:9.

Che Q, Schreiber MJ Jr, Rafey MA. Beta-blockers for hypertension: are they going out of style? Cleve Clin J Med. 2009;76(9):533-42.

Neutel JM. The role of combination therapy in the management of hypertension. Nephrol Dial Transplant. 2006;21(6):1469-73.

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105-87.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, 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(5):507-20.