PRESCRIBING TREND OF ANTIHYPERTENSIVE DRUGS IN SRI GANGANAGAR DISTRICT: A RETROSPECTIVE STUDY

 

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ABOUT AUTHORS:
Amarjeet Singh*, Sudeep Bhardwaj, Ashutosh Aggarwal
Department of Pharmacology,
Seth G. L. Bihani S. D. College of Technical Education,
Institute of Pharmaceutical Sciences & Drug Research,
Sri Ganganagar, Rajasthan 335001, India
*amarjeetsingh024@gmail.com

ABSTRACT
Objective
: The choice of drug for the treatment of hypertension changes at short intervals. Drug utilization studiesconducted at regular intervals help to guide the physician in prescribing drugs rationally. The present study was done toanalyze the prescribing patterns of antihypertensive drugs in a NorthIndian  hospital.

Material & method: A retrospective, crosssectional analysis of prescriptions of antihypertensive cases admitted in Medicine in-patient wards of civil hospital of Sri Ganganagar was conducted. All the prescription files with diagnosis ofessential hypertension were analyzed. Prescriptions for hypertension with other co-morbid conditions were also included. Frequency and proportions of utilization of antihypertensive medications were charted and figured.

Result: During the studyperiod, there were 435 prescriptions for essential hypertension. The most frequently prescribed antihypertensive medications were:  monotherapy (42.06%), (57.94%) of patients were on multiple drugtherapy, the most favored fixed drug combination being diuretics with angiotensin receptor blockers (31.74%).

Conclusion: The present study revealed that Angiotensin receptor blockers arethe drugs of choice as monotherapy and as combination therapy for hypertensives. This pattern of prescription is also supported by the current JNC VIII guidelines for the treatment of hypertension.

REFERENCE ID: PHARMATUTOR-ART-2328

PharmaTutor (ISSN: 2347 - 7881)

Volume 3, Issue 4

Received On: 30/01/2015; Accepted On: 09/02/2015; Published On: 01/04/2015

How to cite this article: A Singh, S Bhardwaj, A Aggarwal; Prescribing Trend of Antihypertensive Drugs in Sri Ganganagar District: A Retrospective Study; PharmaTutor; 2015; 3(4); 53-59

INTRODUCTION
Hypertensive vascular disease is a common entity readily detectable, asymptomatic at times, easily treatable usually and often known to lead to lethal complications if left untreated. It is a clinical syndrome occurring in the general population, characterized by sustained elevation of blood pressure. According to the report of the joint national committee for detection, evaluation and treatment of high blood pressure, hypertension is defined as a clinical statewhere the systolic blood pressure is above 139mmHg and the diastolic blood pressure is above 89mmHg persistently[1]. In the majority of cases, a specificunderlying cause of hypertension is not known. Such patients are said to have essential hypertension[2]. The purpose of treating essential hypertension is toprevent complications and to improve patient survivaland the selection of the antihypertensives should bebased on safety, efficacy and freedom from adverseeffects. Accordingly, appropriate drug therapy canensure immense therapeutic benefit in patients with essential hypertension with least adverse effects. The study of a prescription pattern is in fact, a part ofmedical audit involving monitoring and evaluation ofvarious prescriptions of medical practitioners to ensurerationality in medical care[3]. A prescription-based survey is considered to be oneof the most effective methods to assess and evaluate theprescribing attitude of physicians and dispensingpractice of pharmacists[4].

MATERIAL & METHOD

Prescription collection:
The present study was a retrospective, cross sectionalanalysis of antihypertensive prescriptions whichincluded all prescriptions of hypertensive patientsduring 1 may to 30 may 2014  conductedin the Outpatientand inpatient department of general medicine, orthopedics, eye, emergency, psychiatry, general surgery, skin and dermatologyat Civil hospital Sri Ganganagar Rajasthan. All the prescription files with diagnosis of essentialhypertension (ICD-9CM: 401-405, WHO internationalcode: A 26) were analyzed. This study was carried out after getting approval from the Institutional Ethics Committee of Seth G.L. Bihani S.D. College of Technical Education Institute of Pharmaceutical Sciences & Drug Research. Patients with any stage of hypertension with or without co-morbidities were included in the study. The patient’s demographics, antihypertensive drugs prescribedwere entered in a specially designed proforma. Antihypertensive drugs were grouped into seven categories, namely Angiotensin Converting EnzymeInhibitors (ACEI), Angiotensin receptor blockers(ARB), Beta-blockers (BB), Calcium channel blockers(CCB), Diuretics, Alpha adrenergic blockers andCentral sympatholytic drugs.

RESULTS
A total of 435prescriptions were monitored, of which 272were male and 163were female. The age group of the patients vary from 20– 79years. Among hypertensives,183 (42.06%) patients were under monotherapy, 189(43.44%)patients were undertwo drugcombination therapy, 57(13.10% )patients were under three drug combination therapy and only 6 (1.36% ) patients were under four drug combination therapy. In monotherapy, Angiotensin receptor blocker (Losartan) wasmost commonly prescribed (n=78;42.62%)(Table 2, fig.1). In combination therapy, a two drug combination consisting ofAngiotensin receptor blocker (Losartan)  and diuretics (hydrochlorthiazide) were given to the majority of patients (n=60;31.74%)(Table3, fig.2),a three drug combination of angiotensin receptor blocker (Losartan), calcium channel blocker (amlodipine) and β-blocker (Metoprolol)were given to the majority of patients (n=18;31.75%)(Table no.4, fig.3) and a four drug combination ofangiotensin receptor blocker(Losartan), calcium channel blockers (amlodipine), β-blocker (Metoprolol) and Thiazide (Hydrochlorothiazide) were given to only of patients (n=3) (Table No.5, fig. no.4).

Most of the Monotherapy of hypertension was prescribed in the age group of 50-59 year 25.13%(Table no 6 fig. 5), in the two drug combination therapy was prescribed in the age group of 60-69 year 28.57%(Table no.7 fig 5), in the three drug combination therapy was prescribed in the age group of 40-49 year 33.33%(Table no.8 fig 5).

Monotherapy and combination therapy were  used at rates of 42.06% and 57.93% respectively. Hansson L 1996also reported similar results and suggested that blood pressure could be adequately controlled with the help of combination therapy[5]. Furthermore, combination therapy seems to be a rational approach to reduce the cardiovascular mortality[6]. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High BloodPressure (JNC VI and JNC VII) reports  thatvolume overload due to inadequate diuretic therapy isone of the commonest reasons for resistance tohypertensive treatments [7].

The present studyalsorevealed that Angiotensin receptor blockers arethe drugs of choice as monotherapy and as well as in combination therapy for hypertensives. This pattern of prescription writing following the JNC VIII guidelines which also recommends Angiotensin receptor blocker in monotherapy and as well as in combination therapy.

TABLE NO. 1 Types of Therapy Prescribed

Drug Therapy

Male

Female

Total

P value

Odds ratio

RR

Monotherapy

110(25.28%)

73(16.78%)

183(42.06%)




Combination therapy

162(37.24%)

90(20.68%)

252(57.93%)

0.42ns

0.8371

0.9350

Table no. 2 Mono Therapy of Antihypertensive

Drug

No. Of Patients

Male

Female

P  value

Odds ratio

RR

Atenolol

9(4.91%)

6(3.27%)

3(1.63%)




Metoprolol

18(9.83%)

13(7.10%)

5(2.73%)

0.9304

1.077

1.026

Enalpril

24(13.11%)

7(3.82%)

17(9.28%)

0.0175

4.510

2.229

Remipril

15(8.19%)

9(4.91%)

6(3.27%)

0.0568

0.2745

0.4861

Losartan

78(42.62%)

47(25.68%)

31(16.93%)

0.9852

0.9894

0.9957

Telmisartan

6(3.27%)

5(2.73%)

1(0.54%)

0.2620

0.3032

0.7231

Amlodipine

24(13.11%)

14(7.65%)

10(5.46%)

0.2557

3.571

1.429

Nifedipine

3(1.63%)

3(1.63%)

0

0.1588

0.1973

0.5833

Hydrochlorthaizide

3(1.63%)

3(1.63%)

0




Torasemide

3(1.63%)

3(1.63%)

0




Total

183 42.06%

11025.28%

73

16.78%




Table NO. 3 Two Drug Combination Therapy

Drugs

No.Ofpatients

Male

Female

P value

odds ratio

RR

Amlodipine+Furosemide

3(1.58%)

0

3(1.58%)




Amlodipine+ Metoprolol

6(3.17%)

4(2.11%)

2(1.05%)

0.0578

0.07937

0.000

Losartan+Torasemide

6(3.17%)

5(2.64%

1(0.52%)

0.5050

0.4000

0.8000

Losartan+Enalpril

6(3.17%)

5(2.64%

1(0.52%)

1.000

1.000

1.000

Losartan+Metoprolol

9(4.76%)

7(3.70%)

2(1.05%)

0.7921

1.429

1.071

Losartan+HCTZ

60(31.74%)

38(20.10)

22(11.64%)

0.3962

2.026

1.228

Losartan+Remipril

9(4.76%)

5(2.64%)

4(2.11%)

0.6534

1.382

1.140

Furosemide+Spironolactone

6(3.17%)

2(1.05%)

4(2.11%)

0.3980

2.5

1.667

Enalpril+Metoprolol

3(1.58%)

3(0.68%)

0

0.0578

0.07937

0.3333

Losartan+Amlodipine

42(22.22%)

26(13.75%)

16(8.46%)

0.1830

4.358

1.615

Telmisartan+HCTZ

6(3.17%)

6(3.17%)

0

0.0641

0.1235

0.6190

Telmisartan+Amlodipine

3(1.58%)

0

3(1.58%)

0.0027

91.00

infinity

Remipril+Amlodipine

3(1.58%)

0

3(1.58%)




Remipril+Lisinopril

3(1.58%)

0

3(1.58%)




Remipril+Metoprolol

18(9.52%)

11(2.52%

7(3.7%

0.0497

0.09317

0.000

Remipril+Furosemide

3(1.58%)

3(1.58%)

0

0.1859

0.2190

0.6111

Amlodipine+Atenolol

3(1.58%)

2(1.05%)

1(0.52%)

0.2733

4.200

1.500

Total

 189

 120

 69




Table No. 4 Three Drug Combination Therapy

Drugs

No. Of patients

Male

Female

P value

Odds value

RR

Furosemide+Spironolactone+

Telmisartan

3(5.26%)

3(5.26%)

0




Furosemide+Spironolactone+

Propanolol

3(5.26%)

3(5.26%)

0




Amlodipine+Metoprolol+

Remipril

3(5.26%)

3(5.26%)

0




Furosemide+Spironolactone+

Remipril

3(5.26%)

3(5.26%)

0




Losartan+Hydrochlorthiazide+

Metoprolol

9(15.78%)

4(7.01%)

5(8.77%)

0.0910

8.556

2.250

Losartan+Hydrochlorthiazide+

Amlodipine

9(15.78%)

4(7.01%)

5(8.77%)

1.0000

1.000

1.000

Losartan+Hydrochlorthiazide+

Remipril

3(5.26%)

2(3.5%)

1(1.75%)

0.5050

0.4000

0.6667

Amlodipine+Atenolol+

Enalpril

6(10.52%)

4(7.01%)

2(3.50%)

1.0000

1.000

1.000

Losartan+Amlodipine+

Metoprolol

18(31.57%)

11(19.29%)

7(12.28%)

0.8077

1.273

1.091

Total

 57

 37

 20




Table no. 5 Four Drug Combination Therapy

Drugs

No. Of patients


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