Evaluation of the Prescribing Patterns of Antihypertensive Drugs in Patients of Hypertension with Associated Co-Morbidities at a Tertiary Care Hospital

This study was an attempt to analyze and evaluate the prescribing patterns of antihypertensives and their adherence with published treatment guidelines in patients diagnosed of hypertension with co-morbidities like diabetes, cardiovascular diseases, renal diseases etc at a tertiary care hospital. A prospective, observational, cross-sectional study was conducted in all patients with hypertension and co-morbidities presenting to one of the polyclinics of Internal Medicine OPD of a tertiary care hospital during the study period. Drug utilization data of anti-hypertensives in patients with co-morbidities was collected through daily monitoring of prescriptions and by personally interviewing the patients meeting the inclusion criteria. Confirmed patients were analyzed for social, demographic and clinical variables.

 

A total of 120 hypertensive patients fulfilled the criteria for inclusion in the present study. Monotherapy was used more commonly than combination therapy (53.7% vs 46.3%). From the monotherapy category, various classes of drugs used included calcium channel blockers (48.3%), angiotensin II receptor blockers (32.75%), ACE inhibitors (12.06%) followed by beta-blockers (3.44%). As for individual drugs, Amlodipine (48.3%) was most commonly prescribed. Among the combination therapies, 2-drug treatment was preferred for 76.2% of the hypertensive patients with ACEIS/ARBS+DIURETICS being the most frequent drug combination (62.0%) prescribed. Also T2DM (27.5%) was found to be the most common co-morbid condition associated with hypertension followed by hypothyroidism (17.6%).

 

Effective control of BP was found in 53.3% of patients. Though Telmisartan (ARB) was the most frequently prescribed drug in combination therapy, it did not exist in the hospital formulary and was not provided at the hospital pharmacy. The general pattern of antihypertensive utilization seems to be in accordance with the international guidelines for management of hypertension, but, diuretics were not prescribed as monotherapy. The prescription of branded drugs often results in noncompliance due to poor economic status of a large proportion of hypertensive patients ultimately leading to poor blood pressure control and hence treatment failure. Therefore the set guidelines need to be strictly adhered to so that effective management and treatment is ensured and the risks of cardiovascular morbidity and mortality get minimized.