ABSTRACTABSTRACT

ABSTRACT:

BACKGROUND: To conduct a prospective observational study on prescribing pattern of anti-hypertensive drug in the department of GENERAL MEDICINE in Government District hospital, Gulbarga. In this study it was aimed to evaluate the current practice of anti-hypertensive drug by comparing with JNC-8 guidelines in population. OBJECTIVES: The objective of our study is to determine the prescription pattern of antihypertensive drugs and adherence to JNC8 guidelines and to find out the most prescribed anti-hypertensive drugs. Methods: A Prospective Observational Study of 06 months was conducted. Undertaken 174 patients data collection form of all the patients of inpatient department of age 18 ? years of hypertensive with or without co-morbidities. Result: The results of this analysis suggests that out of the total 174 hypertensive patients included in the study, 92 patients were males while 82 patients were females, indicating the higher prevalence of hypertension in male population than in female population, that is 10% higher prevalence in males than in females. Out of the total study subjects, 169 hypertensive patients were found to have other co morbid conditions. Considering out of the total 174 patients, majority of the patients received monotherapy (129) while remaining patients receiving the Combinational therapy are 45. However in the case of overall utilization pattern of antihypertensive agents, CCBs are the most frequently prescribed class of drugs, followed by ARBs , BBs and finally ACEIs .

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KEYWORDS: ACEI, ARB, BB, CCB, DM, HTN.
INTRODUCTION:
Hypertension is the major health problem and the expenses of its treatment are high. In the united states, approximately 50 million people have been diagnosed with hypertension, and half of them are treated with anti-hypertensive medication. In the early 1980’s calcium antagonist and angiotensin converting enzyme inhibitors gained ground as the first line anti-hypertensive drugs. 1
Antihypertensive pharmacotherapy effectively reduces hypertension-related morbidity and mortality. Appropriate pharmacotherapy for uncomplicated hypertension assumes paramount importance to public health because _70% of US hypertensive adults lack co-morbidities that compel the use of certain antihypertensive drug. 2
Most patients with hypertension require two or more antihypertensive medications. Thiazide diuretics, ?-blockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers and calcium channel blockers have all been shown to reduce complications of hypertension and may be used for initial drug therapy. In 2002, a clinical trial comparing different classes of antihypertensive medications for initial therapy found that chlorthalidone, a thiazide diuretic, was as effective as other agents in reducing coronary heart disease, death and non fatal myocardial infarction. The drug was superior to amlodipine in preventing heart failure and to lisinopril in preventing stroke. Selection of antihypertensive agents should therefore be based primarily on the comparative ability to prevent these complications. 3
More than 50% of treated hypertensive patients have a blood pressure level greater than 140/90 mm Hg (uncontrolled hypertension). Several factors including, among others, poor adherence to therapeutic regimen, ignorance, and poverty have been adduced for the high prevalence of uncontrolled hypertension. Recent reports have however focused on the role of health care provider to poor adherence to antihypertensive drugs. Consequently, compliance with standard guidelines aiding physicians in effective prescription of antihypertensive drugs have been emphasized. This study is aimed at determining the physician’s prescription pattern of antihypertensive medications in a tertiary health institution in north western Nigeria. Physician’s compliance with the existing guidelines is described. 4
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is the largest randomized trial ever conducted to compare antihypertensive medications. Sponsored by the US National, Heart, Lung, and Blood Institute in conjunction with the US Department of Veteran’s Affairs, ALLHAT was designed to compare the efficacy of 4 types of antihypertensive medications – chlorthalidone (a thiazide-type diuretic), amlodipine (a calcium channel blocker CCB), lisinopril (an angiontensin-converting enzyme ACE inhibitor) and doxazosin (an ?-adrenergic blocker) – for reduction of risk of coronary heart disease (CHD) or other cardiovascular events .5
The seventh report of the joint national committee on the detection evaluation and treatment of high blood pressure (JNC 7) is the most prominent evidence based clinical guideline for the management of the hypertension. 6
JNC 8 Guidelines 7:
Hypertension is one of the most important preventable contributors to disease and death in the United States, leading to myocardial infarction, stroke, and renal failure when it is not detected early and treated appropriately. The Eighth Joint National Committee (JNC 8) recently released evidence-based recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults. In the general population of adults 60 years and older, pharmacologic treatment should be initiated when the systolic pressure is 150 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. Patients should be treated to a target systolic pressure of less than 150 mm Hg and a target diastolic pressure of less than 90 mm Hg. Treatment does not need to be adjusted if it results in a systolic pressure lower than 140 mm Hg, as long as it is not associated with adverse effects on health or quality of life.In the general population younger than 60 years, pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg.

AIM & OBJECTIVE:
To determine the prescribing pattern of anti- hypertensive drugs in the department of general medicine & to find out the most prescribed anti-hypertensive drugs.
METHODOLOGY:
A prospective observational study involving 174 patients carried out at Department of GENERAL MEDICINE, Gulbarga dist hospital, for the period of 6 Months (October 2016 to March 2017) Patients The data is collected from all the patients of either sex with primary and secondary hypertension in medicine inpatient department and who are willing to participate in the study, & not from the Patient below the age of 18 years, pregnant women and patients who are not willing to participate in the study. Patient data relevant to the study will be obtained from Case-sheets, medication chart & laboratory reports.