Drug utilisation study on hypertension patient
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Drug Utilization Study on Hypertension Patients
Introduction to Hypertension and Drug Utilization
Hypertension, a leading risk factor for cardiovascular diseases, stroke, and renal failure, necessitates effective management through antihypertensive medications. Drug utilization studies are crucial for understanding prescribing patterns and ensuring rational drug use, which can significantly impact patient outcomes.
Trends in Antihypertensive Medication Use
Increasing Use of Antihypertensive Medications
Studies have shown a significant increase in the use of antihypertensive medications over the years. For instance, in the United States, the percentage of hypertensive adults taking prescription antihypertensive medications rose from 57.3% in 1988-1994 to 62.9% in 1999-2002. This trend was particularly notable among men, whose usage increased from 47.5% to 57.9% during the same periods. Similarly, in a tertiary care hospital in India, the average number of drugs prescribed per prescription was 4.18, with a majority of patients on multiple drug regimens.
Polytherapy and Monotherapy Patterns
Polytherapy, or the use of multiple antihypertensive drugs, has become more common. In the US, the use of multiple antihypertensive drugs increased from 29.1% to 35.8% between the two survey periods. In the Queen Mary Utilization of Antihypertensive Drugs Study, the percentage of patients on three or more drugs increased from 7% in 1996 to 22% in 2004. In contrast, monotherapy with diuretics or beta-blockers has decreased.
Commonly Prescribed Antihypertensive Drug Classes
Calcium Channel Blockers and Beta-Blockers
Calcium channel blockers (CCBs) and beta-blockers (BBs) are consistently popular choices for treating hypertension. In the Queen Mary study, the use of CCBs increased from 51% in 1996 to 65% in 2004, while BBs usage rose from 46% to 64% during the same period. Similarly, in a tertiary care hospital in India, CCBs were the most commonly prescribed class, followed by beta-blockers.
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are also frequently prescribed. In the US, the use of ACEIs increased by 68% between the survey periods. In a Nigerian study, ARBs were the most frequently prescribed class, with Losartan being the most common.
Adherence to Clinical Guidelines
Following Joint National Committee Guidelines
Many studies indicate that prescribing patterns generally adhere to established guidelines. For example, in a tertiary care hospital, the prescription patterns were found to be rational and mainly in accordance with the Joint National Committee VIII guidelines. Similarly, in a private healthcare setting in Nigeria, drug utilization was in agreement with JNC 7&8 recommendations.
Areas for Improvement
Despite adherence to guidelines, there are areas for improvement. For instance, the underutilization of fixed-dose combination therapies and the over-prescription of beta-blockers were noted in a study of patients with uncontrolled hypertension in the US. Additionally, the use of thiazide diuretics, ARBs, statins, and aspirin was found to be underutilized despite favorable clinical trial evidence.
Conclusion
The utilization of antihypertensive medications has increased over the years, with a notable shift towards polytherapy. Calcium channel blockers and beta-blockers remain popular, while ACEIs and ARBs are also commonly prescribed. Although adherence to clinical guidelines is generally good, there is room for improvement in prescribing practices, particularly in the use of fixed-dose combinations and the rational use of all drug classes. These insights highlight the importance of continuous monitoring and evaluation of drug utilization patterns to optimize hypertension management.
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