Prescription Monitoring of Antihypertensive Drug Utilization for Uncomplicated Hypertension Patients in a Tertiary Hospital: A Cross Sectional Study in the Inpatient Wards

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About Authors: N. V. R. Praveen Kumar. T, Mohanta. G. P, Sudarshan. S# and Parimalakrishnan. S.
Department of Pharmacy, Annamalai University,
Annamalai Nagar – 608002.Tamil Nadu, India.
# Department of Medicine, Rajah Muhtiah Medical College and Hospital, Annamalai University,
Annamalai Nagar – 608002.Tamil Nadu, India.

Reference ID: PHARMATUTOR-ART-1079

Abstract
Objective
The study was conducted to identify and evaluate the Prescription Monitoring of Antihypertensive Drug Utilization for Uncomplicated Hypertension Patients.

Methodology
This was a prospective observational study and was approved by IRB.  The study was conducted in tertiary care teaching hospital, which is located at southern part of India having 1210 beds.  Totally 1262 prescriptions were studied.

Results
Total distribution of patients with respect to age group showed that highest number of patients was found in the age group of 60-69 years (31.3%) and least was found between 20-29 years age group (1.1%). Majority of males in the study population (43.29%) were found to have both the habits of smoking and alcohol. Among concomitant diseases that were related to hypertension Coronary artery disease was highest (67.78%) and giddiness was least (1.7%). In case of diseases unrelated to hypertension Type II diabetes mellitus was observed as highest (38.7%) and acute gastroenteritis was recorded least (5.68%). Overall 43.5% patients were treated with single antihypertensive drug and 53.8% were treated with antihypertensive drug combinations.

Introdution
Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure. According to Medilexicon's medical dictionary, hypertension means "High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences [1]."

Cardiovascular diseases have emerged as an important health problem in India. High blood pressure (BP) is a major risk factor and better control can lead to prevention of 300,000 of the 1.5 million annual deaths from cardiovascular diseases in India. Epidemiological studies demonstrate that prevalence of hypertension is increasing rapidly among Indian urban populations and using the current definitions more than two-fifths of the Indian urban adult population has hypertension [2].

The normal level for blood pressure is below 120/80, where 120 represents the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension and a blood pressure of 140/90 or above is considered hypertension. Hypertension may be classified as essential or secondary. Essential hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors, or birth control pills [3,4].

Reviews of studies on hypertension epidemiology in India have shown high prevalence in both urban and rural areas [5]. In population-based studies, Joseph et al. reported it in 31% men and 41% women in Thiruvananthapuram, [6] while Mohan et al. reported a crude prevalence rate of 21% in Chennai [7].

High blood pressure may be treated medically, by changing lifestyle factors, or a combination of the two. Important lifestyle changes include losing weight, quitting smoking, eating a healthful diet, reducing sodium intake, exercising regularly, and limiting alcohol consumption. Medical options to treat hypertension include several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, α-blockers, and peripheral vasodilators are the primary drugs used in treatment [8]. These medications may be used alone or in combination, and some are only used in combination. In addition, some of these drugs are preferred to others depending on the characteristics of the patient (diabetic, pregnant, etc.).

The guidelines differ with regard to which drug class is to be considered as first choice for the initial treatment of hypertension with no complications [9]. Thiazide diuretics have been recommended by the seventh report of the joint National Committee [10] and the British Hypertension society as the preferred first-line antihypertensive due to its affordability [11] and evidence on its efficacy in the prevention of cardiovascular events in those with hypertension [12]. The objectives of this study are to monitor prescription pattern of antihypertensive medications of uncomplicated hypertension and to identify the determinants of the choice of first-line drug therapy was undertaken in the inpatient department. Physicians’ compliance with the existing guidelines is described.

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