A study on drug prescription pattern of antihypertensives in a tertiar

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

slide 1:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 355 IJAMSCR |Volume 4 | Issue 3 | July - Sep - 2016 www.ijamscr.com Research article Medical research A study on drug prescription pattern of antihypertensives in a tertiary care hospital Anjali T 1 Sarath Sasikumar 2 Vineetha S 3 Sari. S. Nair 4 1 Nehru college of pharmacy KUHS University Thrissur Kerala India. 2 Department of pharmaceutical sciences M.G University Kottayam Kerala India. 3 Nehru College of pharmacy KUHS University Thrissur Kerala India. 4 Nehru College of pharmacy KUHS University Thrissur Kerala India. Corresponding author: Anjali T Email id: anjalit86gmail.com ABSTRACT Background and Aim: Hypertension is an important public health challenge because of the associated morbidity and mortality caused by cardiovascular diseases and the cost to the society. Methods and Results: The study group consisted of four hundred patients who attended the outpatient department of Medicine at Medical College Thiruvananthapuram. At base line patient demographics family history which includes previous history of hypertension and any other co-morbidity were assessed using the preform. The cost of antihypertensives has to be determined by using the information available from the Kerala Medical Services Corporation Limited KMSCL and National Pharmacy Pricing Authority NPPA. The salient findings of the study are: 60.5 were females and 39.5 were males. Majority of the patients were under the age group of 60-69 31.5 70- 79 25 and 50-59 22.5. 50.8 patients were treated with monotherapy and 49.3 patients were treated with combination therapy. During the cost analysis the mean cost of antihypertensive was found to be Rs.0.30 in monotherapy and in combination therapy it was found to be Rs.1.2. Conclusion: The present study represents the current prescribing trend for antihypertensive agents and it highlights certain shortcomings in the existing prescribing practice. Keywords: Hypertension Antihypertensives Monotherapy Combination therapy. INTRODUCTION Cardiovascular diseases have emerged as an important health problem in India. In India cardiovascular diseases cause 1.5 million deaths annually 1. According to Joint National Committee JNC 7 hypertension is defined as a systolic blood pressure SBP higher than 140 mmHg or a diastolic blood pressure DBP higher than 90 mmHg the diagnosis is based on the average of two or more readings taken at each of two or more visits after an initial screening 2. Despite the prevalence of hypertension and its associated complications only 29 of patients with hypertension are treated and only 45 of those treated with antihypertensive medications have controlled disease. Now a day’s hypertension remains poorly controlled. It is due to multiple factors including low antihypertensive efficacy of ISSN:2347-6567 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

slide 2:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 356 single drug therapy 3 reluctance of primary care physicians to modify or titrate initially chosen therapy to obtain target blood pressure and poor compliance with medication. Several guidelines for the treatment of high blood pressure now include combination therapy with low doses of two drugs as one of the strategies for the initial management of mild or moderate arterial hypertension 4. Commonly used combination anti hypertensives include diuretic and potassium sparing diuretics beta blockers and diuretics angiotensin-converting enzyme ACE inhibitors and diuretics angiotensin- receptor II antagonists and diuretics 5 and calcium channel blockers and ACE inhibitors. The National Health and Nutrition Examination Survey NHANES report showed that blood pressure is controlled to a level below 140/90 mm Hg in only 27 percent of patients diagnosed with hypertension 6. Because monotherapy is effective in achieving this target goal in only about 50 percent of patients treatment with two or more agents from different pharmacologic classes is often necessary to achieve adequate blood pressure control 7. It is therefore important to understand current antihypertensive medication utilization patterns and to study their impact on blood pressure control and hypertension-related clinical outcomes 8. MATERIALS AND METHODS It was a cross sectional study The study was started after getting clearance from Human Ethics Committee Medical College 9 Thiruvananthapuram the study duration was four months. The out patients with hypertension attending the department of medicine were enrolled in the study. The consent of the selected patients were taken in the prescribed format Appendix II. At baseline subjects demography which includes age gender education income family history which includes previous history of hypertension 10 and any other co-morbidities were assessed using the proforma. The monotherapy and combination therapy of anti hypertensives used by the patients was noted from the patient case sheet 12. A separate data entry format Appendix I was designed. The drug chart was also included in the data entry format. Data was collected from the patient case sheet and transferred to data entry format for evaluation 13. Cost benefit analysis was conducted by taking direct cost of drug alone for that cost was determined from Kerala Medical Services Corporation Limited KMSCL the authorized procuring agent for government institution in the state of Kerala 14. And the drugs which are not supplied by KMSCL the cost was evaluated from National Pharmacy Pricing Authority NPPA 15. The data were entered in Microsoft Excel format and the statistical analysis was done by using Statistical package for the Social Sciences SPSS for windows version 11.0. Chi- Square tests Student t-test ANOVA are the statistical technique used 16. RESULTS AND DISCUSSION Gender distribution of patients The study group consisted of 242 females 60 and 158 males 39.5. The literate women are more in Kerala hence women were more aware about their health compared to men. Framingham Heart study investigators recently reported the life time risks of hypertension were 86 to 90 in women and 81 to 83 in men. Age distribution of patients According to age total population was divided in to seven groups. Result shows that 60-69 age groups occupy higher percentage of 31.5 and lowest 0.5 in below 30 age group. 25 were between 70-79 years 22.5 were between 50-59 years 11.8 were between 40-49 years 7 were 39.5 60.5 Male Female

slide 3:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 357 between 30-39 years 1.8 was between above 80 age group. Education Out of the total population included for the study 5.3 were uneducated 33 were below matriculation 54.3 were matriculation and 7.5 were graduated. Family history of hypertension A total of four hundred patients 320 patients having family history of hypertension and 80 patients having no family history of hypertension. Co-morbidities Hypertension usually associated with co- morbidities such as congestive heart failure diabetes myocardial infarction stroke kidney failure etc. The analysis of this study population shows that 29.3 had diabetes 21.8 had congestive heart failure 12 had kidney failure 5.5 had myocardial infarction and 2 had stroke. Hence hypertension is an important risk factor for these disorders. The relationship between 80 20 Yes No

slide 4:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 358 BP and risk of CVD events is continuous consistent and independent of other risk factors. The higher the blood pressure the greater is the chance of heart attack heart failure stroke and kidney diseases. Numerous studies shown that blood pressure is directly associated with the risks of several types of cardiovascular diseases and the associations of blood pressure with the disease risk are continuous with large proportions of most populations having non-optimal blood pressure values. Common symptoms The common symptoms of the study population were found to be 95.5 had giddiness 27 had vomiting 26.3 had breathing difficulty 21.5 had sweating and various other symptoms like nausea general tiredness loss of consciousness headache were found in 5.5 populations. Monotherapy Monotherapy is able to normalize blood pressure in less than a quarter of patients with hypertension. The result of this study shows that out of four hundred patients 203 patients were treated with monotherapy. In that 45.3 patients were treated with Amlodipine 19.2 patients were treated with atenolol 14.8 patients were treated with losartan 10.3 patients were treated with metoprolol 4.9 patients were treated with enalapril and other patients were treated with frusemide nebivilol and nifedipine.

slide 5:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 359 Monotherapy Vs polytherapy The treatment of hypertension must fall within a strategy of the early and strict control of blood pressure levels. Only actual normalization of blood pressure can offer long term benefit regarding the incidence of cardiovascular morbidity and mortality. The statistical analysis of the present study indicates that 50.8 of the study populations were treated with monotherapy and 49.2 patients were treated with combination therapy. The present study does not show any significant difference in percentage of population treated with monotherapy and combination therapy. Monotherapy is able to normalize blood pressure in less than a quarter of patients with hypertension. However for a disease of multifactorial pathogenesis like essential hypertension a therapeutic strategy employing different principles of actions is most suitable. In addition combination therapy has many advantages. Blood pressure reduction is improved by an additive effect and through neutralization of compensatory counter-regulatory reactions. The number and severity of adverse effects are reduced by lower dose requirements. Furthermore combination therapy is expected to reduce costs and to improve therapeutic compliance. The initial low-dose combination therapy has been shown to be superior as compared to treatment by the stepped-care and the sequential monotherapy approach. Recently therefore low-dose combination therapy has been recommended for initial antihypertensive therapy instead of the stepped- care approach or of sequential monotherapy. Cost of antihypertensive drugs In addition to efficacy and safety the cost of therapy has become an increasingly important factor to consider when selecting drugs to treat patients with mild to moderate hypertension. An attempt was made to calculate the cost required only by antihypertensive drugs. The study revealed that the cost of antihypertensives used by the patient in a Government tertiary care hospital ranges from Rs. 0.10 to Rs. 1.10 per day in the case of monotherapy.

slide 6:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 360 Monotherapy drug Mean SD N F P Amlodipine 0.1 0.1 91 109.75 0.000 Losartan 0.3 0.2 30 Enalapril 0.4 0.6 10 Atenolol 0.1 0.1 39 Metoprolol 1.1 0.3 21 Frusmide 0.1 0.0 8 Significant at 0.01 level Comparison of cost based on monotherapy and poly therapy On analysis the study shows that the cost of antihypertensives in polytherapy is higher than that of monotherapy. The mean cost of antihypertensive in monotherapy were found to be Rs.0.30 and cost of antihypertensive in polytherapy were found to be Rs.1.2. CONCLUSION Hypertension is one of the most important modifiable risk factor for cardiovascular diseases. A prescription based survey is considered to be one of the most effective methods to assess and evaluate the prescribing attitude of physicians and dispensing practice of pharmacists. It is also important to consider the recommendations of international bodies on hypertension that help to improve prescribing practice of the physicians and ultimately the clinical standards. A continuous supervision is therefore required through such kinds of systematic audit that provide feedback from the physician and help to promote rational use of drugs. The present study represents the current prescribing trend for antihypertensive agents and it highlights certain shortcomings in the existing prescribing practice. There is a considerable scope for improvement particularly the under utilization of diuretics in the present prescribing pattern of antihypertensive drugs. Sincere and sustained efforts in a step-wise manner appear to be the only answer to make a start and gradually achieve this goal. Acknowledgement The authors acknowledge Medical College Thiruvananthapuram and College of pharmaceutical sciences for their support fulfilment of this work. REFERENCES 1. Rajeev Gupta V.P Gupta Hypertension epidemiology in India: lessons from Jaipur heart watch 97 2009 3 10. 2. Shahina P.T Revi Kumar K.G Krishnan R Jaleel V.A Shini V. K The impact of pharmacist interventions on 49.3 50.8 monotherapy polytherapy

slide 7:

Anjali T et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-43 2016 355-361 361 quality of life in patients with hypertension 53 2010. 3. Bethesda. Seventh report of Joint National Committee on prevention detection evaluation and treatment of high blood pressure. National heart lung and blood institute National high blood pressure education programme 2003. 4. Carter BL. Highlights of the sixth report of Joint National Committee on prevention detection evaluation and treatment of high blood pressure. Am. J. Health syst pharm. 55 382 1998. 5. Burt VL Cutler J A Higgins M et al. Trends in the prevalence awareness treatment and control of hypertension in the adult US population: data from the health examination surveys 1960 to 1991. Hypertension: 1995 60. 6. Pickering TG. Optimal blood pressure levels. Am. J. Hypertension 11 1998 877. 7. Neil S. Skolnik M D. Combination antihypertensive drugs Recommendations for use. Am. Fam physician 61 2000 3049-56. 8. Materson BJ Red DJ Cushman WC Massie BG Fries ED Kochar MS et al. Single drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. New England Journal of Medicine 328 1993 914-21 9. Aram V. Chobanian George L. Bakris Henry P. Black. Seventh report of Joint National Committee on prevention detection evaluation and treatment of high blood pressure. Hypertension.42 2003 1206-1252. 10. Dipiro JT Talbert RL Yee GC Mateke GR Well BG Posey LM. Pharmacotherapy- A pathophysiologic approach. Sixth edition. New York Mc Graw Hill professions divisions 2005 194-197. 11. M C S Wong J Y Jiang A T Lam H Fung S Griffiths and S W Mercer et al. Patterns of antihypertensive prescribing discontinuation and switching among a Hong Kong Chineese population from over one million prescription research letter. J. Hypertension: 2008 56-60. 12. Kearney P. Whelton M Reynold K Muntner P Whelton P.K Hc J et al. Global burden of hypertension: Analysis of worldwide data. Lancet 365 2005 217-223. 13. Rodgers A Lawes C Mac Mahon S et al. Reducing the global burden of blood pressure related cardiovascular diseases. Journal of Hypertension: 181 2000 S3-S6. 14. Doggrell Sheil A et al. Is amlodipine the best initial monotherapy for hypertension Expert opinion on pharmacotherapy 76 2006 829-832. 15. M S Kochar D Trottier G Kotecki M Forbes et al. Sequential monotherapy of hypertension. Clinical pharmacology: 3412 1994 1173-1176. 16. Heinrich Holzgreve et al. Combination versus monotherapy as initial treatment in hypertension. 28 8 725- 732. How to cite this article: Anjali T Sarath Sasikumar Vineetha S Sari. S. Nair. A study on drug prescription pattern of antihypertensives in a tertiary care hospital. Int J of Allied Med Sci and Clin Res 2016 43: 355-361. Source of Support: Nil. Conflict of Interest: None declared.

authorStream Live Help