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Background: Anti-hypertensive drugs can effectively control hypertension, subject to good adherence. Uncontrolled hypertension can lead to numerous complications, some even potentially fatal, such as myocardial infarction, atherosclerosis, thromboembolism, shock and stroke.Methods: A cross-sectional prospective study was conducted with the help of a pre-validated questionnaire during the course of 6 months in the medicine outpatient department and the inpatient department (wards) at a tertiary care hospital, Navi Mumbai in 200 hypertensive patients to calculate the correlation of the sociodemographic factors with adherence by the chi-squared test.Results: The overall percentage of adherence to antihypertensive medication was 34.8%. It was the highest (72.1%) in the younger age group, i.e., below 50 years. It was observed that as the age increases, the adherence to treatment decreases. Adherence rates were significantly higher among females and those individuals who had never attended school. Among the employed, 70.3% were adherent to their treatment and among the unemployed, 64.4% were adherent. The percentage of adherence was lower in alcohol consumers (9.5%) as compared to nonusers (76% and 32%, respectively).Conclusions: The clinician advising anti-hypertensive therapy should provide thorough counselling and stress on the issues created due to poor medication adherence as hypertension can be associated with severe outcomes. Treatments should be given in accordance with each patient’s lifestyles in mind such that they may continue taking their medications till the completion of their therapy.
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@#A majority of hypertensive patients will end up suffering uncontrolled hypertension, which is partly due to poor medication adherence. This paper aimed to review a range of interventions that could improve anti-hypertensive medication adherence. Literature search was conducted using PubMed, Scopus, Medline, and Science Direct databases, with publication dates confined to between October 2009 and October 2019. Eventually, only 11 studies were used for this study. It was found that interventions that are based on or include patient education, patient interviews, patient reminders, self-management and behavioural modifications have the potential to improve patients’ adherence to anti-hypertensive therapy. Most successful interventions involve patient reminder, self-management and behavioural intervention.
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Introduction: Hypertension is a multi-factorial and complex disease that has both environmental and genetic determinants. It is the single most significant risk factor for heart diseases and kidney diseases. Hypertension is a leading contributor to global burden of morbidity and mortality. It is considered as a silent killer because most of the time it is asymptomatic and goes undetected. Hence, hypertensive patients should be prescribed properly. Objectives: To evaluate the prescribing pattern of anti-hypertensive drugs in patients of hypertension. Material and Methods: This was an observational, cross sectional study conducted over a period of 1 year on hypertensive patients attending the Cardiology out-patient department of Government Medical College and Rajindra Hospital, Patiala and fulfilling the inclusion and exclusion criteria. The prescriptions were evaluated. Results: 22% of prescriptions had monotherapy, amongst which beta-blockers were most commonly prescribed. Majority of prescriptions had two drug therapy (47%), among which ARB+ beta blockers (17%) were most frequently prescribed. Beta blockers +CCB (9%) was the most common Fixed Drug Combination (FDC) prescribed. ARB+beta blockers+diuretics (14%) and ACEI+ARB+beta blockers+diuretics (1%) were most commonly prescribed three drug combinations. Among four drug combinations, only ACEI+ARB+beta blockers+diuretics was prescribed to 1% patients. Hypolipidemic drugs (66%) were maximally co-prescribed. Conclusions: A high trend of polypharmacy was observed in hypertensive patients. So, emphasis is needed to reevaluate the prescribing trends in these patients.
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Introduction: Hypertension is a multi-factorial and complex disease that has both environmental and genetic determinants. It is the single most significant risk factor for heart diseases and kidney diseases. Hypertension is a leading contributor to global burden of morbidity and mortality. It is considered as a silent killer because most of the time it is asymptomatic and goes undetected. Hence, hypertensive patients should be prescribed properly. Objectives: To evaluate the prescribing pattern of anti-hypertensive drugs in patients of hypertension. Material and Methods: This was an observational, cross sectional study conducted over a period of 1 year on hypertensive patients attending the Cardiology out-patient department of Government Medical College and Rajindra Hospital, Patiala and fulfilling the inclusion and exclusion criteria. The prescriptions were evaluated. Results: 22% of prescriptions had monotherapy, amongst which beta-blockers were most commonly prescribed. Majority of prescriptions had two drug therapy (47%), among which ARB+ beta blockers (17%) were most frequently prescribed. Beta blockers +CCB (9%) was the most common Fixed Drug Combination (FDC) prescribed. ARB+beta blockers+diuretics (14%) and ACEI+ARB+beta blockers+diuretics (1%) were most commonly prescribed three drug combinations. Among four drug combinations, only ACEI+ARB+beta blockers+diuretics was prescribed to 1% patients. Hypolipidemic drugs (66%) were maximally co-prescribed. Conclusions: A high trend of polypharmacy was observed in hypertensive patients. So, emphasis is needed to reevaluate the prescribing trends in these patients.
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Background: Hypertensive disorders in pregnancy remain a major cause of maternal and neonatal morbidity and mortality worldwide. This study prospectively examined the immediate neonatal outcome of women with maternal hypertensive disorder of pregnancy (HPD).Methods: This is a prospective study conducted at NICU in Universal College of Medical Sciences Hospital over a period from 2nd February 2018 to 1st February 2019. Fifty-two mothers and their newborn were selected. Mothers with gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension and chronic hypertension were included.Results: Mean maternal age was 26.4 years. Mean gestational age was 34±4 weeks. 38 were male and 24 were female with male: female ratio 1.72:1. Thirty seven (71.2%) mothers needed lower uterine caesarian section, fourteen (26.9%) mothers delivered NVD and one (1.9%) forceps delivery. Low birth weight (<2.5kg) babies were 25 (48.1%%), very low birth weight (<1.5kg) were 9 (17.3%) and normal weight were 18 (34.3%). Intrauterine growth retardation (IUGR) were 18(30%). Perinatal asphyxia 10 (19.2%) were most common cause of admission, other cause of admission were sepsis and prematurity.Conclusions: Eclampsia is still a common and serious complication of pregnancy. Proper antenatal care, detection of preeclampsia with early management and timely referral of high risk patient, administered of MgSO4 in correct doses and properly timed caesarean section in selected cases would reduce the incidence of eclampsia associated maternal and perinatal morbidity and mortality in our facility.
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Background: Drug prescription in menopause is complex as estrogen deficiency, hypertension (HT) and other risk factors, rapidly increase the risk of cardiovascular diseases (CVD) in post-menopausal women (PMW). Objectives: To evaluate the prescription trends of anti-hypertensive drugs in PMW. Methods: This was an observational, cross sectional study conducted over a period of 1 year, on hypertensive PMW. The prescriptions were evaluated for antihypertensive drug use patterns and also as per WHO core drug indicators. Results: 21.82% of prescriptions had monotherapy, amongst which angiotensin receptor blockers (ARB) (10%) and individually, telmisartan (5.45%) were most commonly prescribed. Majority of prescriptions had two drug therapy (44.09%), among which ARB + beta-blockers (BB) (20.91%) and individually, Telmisartan + Metoprolol (13.64%) were most frequently prescribed. ARB + Diuretic (DI) (9.55%) was the most common fixed drug combination (FDC) prescribed. ARB + BB + DI (10.45%), ARB + 2DI + BB (4.09%) and ARB + 2DI + BB + Calcium channel blocker (1.82%) were most commonly prescribed three, four and ≥five drug combinations, respectively. Hypolipidemic drugs (60.45%) were maximally co-prescribed. Percentage of drugs prescribed by generic name was 4.63% and from essential drug list was 32.62%. Conclusions: A high trend of polypharmacy was observed in hypertensive PMW. HT, being a multifactorial disease, deserves a multidisciplinary and a comprehensive approach in the care of this population subgroup. Knowledge of prescription pattern and thus the rational utilisation of drugs will help achieve better control rates of HT and hence curb down the burden of CVDs in PMW.
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Background: Drug prescription in menopause is complex as estrogen deficiency, hypertension (HT) and other risk factors, rapidly increase the risk of cardiovascular diseases (CVD) in post-menopausal women (PMW). Objectives: To evaluate the prescription trends of anti-hypertensive drugs in PMW. Methods: This was an observational, cross sectional study conducted over a period of 1 year, on hypertensive PMW. The prescriptions were evaluated for antihypertensive drug use patterns and also as per WHO core drug indicators. Results: 21.82% of prescriptions had monotherapy, amongst which angiotensin receptor blockers (ARB) (10%) and individually, telmisartan (5.45%) were most commonly prescribed. Majority of prescriptions had two drug therapy (44.09%), among which ARB + beta-blockers (BB) (20.91%) and individually, Telmisartan + Metoprolol (13.64%) were most frequently prescribed. ARB + Diuretic (DI) (9.55%) was the most common fixed drug combination (FDC) prescribed. ARB + BB + DI (10.45%), ARB + 2DI + BB (4.09%) and ARB + 2DI + BB + Calcium channel blocker (1.82%) were most commonly prescribed three, four and ≥five drug combinations, respectively. Hypolipidemic drugs (60.45%) were maximally co-prescribed. Percentage of drugs prescribed by generic name was 4.63% and from essential drug list was 32.62%. Conclusions: A high trend of polypharmacy was observed in hypertensive PMW. HT, being a multifactorial disease, deserves a multidisciplinary and a comprehensive approach in the care of this population subgroup. Knowledge of prescription pattern and thus the rational utilisation of drugs will help achieve better control rates of HT and hence curb down the burden of CVDs in PMW.
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Background: Regression of ventricular hypertrophy is the restoration of normal ventricular structure and physiology after the hypertrophy has developed. It has been clearly demonstrated that once left ventricular hypertrophy (LVH) is diagnosed, it represents a strong blood pressure independent risk factor for cardiovascular morbidity and mortality. Aims and Objectives: The aim of this study is to compare the effectiveness of different anti-hypertensive agents in reducing LVH in Bangladeshi population. Methods: A prospective observational study was carried out to detect the regression of left ventricular hypertrophy in hypertensive Bangladeshi population using high resolution M-mode echocardiographic study in 110 patients with clinically diagnosed hypertension were included in this study but later 15 patients failed to attend clinic for subsequent follow up. Hence, total number of patient was 95; The mean age (±SD) of these patients were 42 ± 5 and male-female ratio was 8.5:1.5. Out of these 95 patients, 20 were included in Beta-blocker(BB) group, 14 in Angiotensin converting enzyme inhibitor(ACEi) group, 20 in Beta-blocker(BB) + Diuretic(DD), 14 were recruited in Angiotensin enzyme inhibitor(ACEi) + Diuretics(DD) and 13 in Beta-blocker and ACEi group and 14 in BB + ACEI + Diuretic group. We followed these patients after 8 weeks, 6 months, 1 year and 2 years in our clinic. A baseline M-mode echocardiography was done to document LVH. During this follow up, we have measured IVSd, PWd, LVIDd and LVIDs and statistically analyzed SD and P-value for each group by using SPSS software. The duration of study was from 01.07.2005 to 30.06.2008. Results: Comparison of Beta blocker alone and ACEi alone group for LVH regression showed a P value of 0.59. Although this figure did not show a statistically significant value if we increase number of patients in both group we would expect a statistically significant P value in favour of ACEi. BB plus diuretics was compared with ACEi plus Diuretics which showed P value of 0.85. We also compared BB plus ACEi group with BB plus ACEi plus DD for LVH regression which showed a P value of 0.79. Conclusion: Among three groups of anti-hypertensive drugs, angiotensin converting enzyme inhibitor(ACEi) alone has been found to be most effective as compared to Beta blockers when used alone than in combination groups with (Beta blocker plus ACEi plus Diuretics or Beta blocker plus ACEi). Although, these figure was not found statistically significant a clear benefit has been shown in all groups in terms of LVH regression and essentially if the power or size if this is increased a statistically significant value of LVH regression value may be observed in all these groups.
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Background: Hypertension is one of the major causes of morbidity, mortality and needs lifelong treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out price variations in the oral antihypertensive drugs available either singly or in combination and number of manufacturing companies for each, also to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July October 2013 and “Indian Drug Review” September 2013. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation of the commonly used drugs found was amlodipine (5 mg): 1128.57%, atenolol (12.5 mg): 683.53%, enalapril (10 mg): 394.67%, telmisartan (20 mg): 288.33%. Among the combination therapy, amlodipine + atenolol (5 + 50 mg): 673.79%, amlodipine + losartan (5 + 50 mg): 284.61%, telmisartan + hydrochlorothiazide (40 + 12.5 mg): 293.85%, losartan + hydrochlorothiazide (50 + 12.5 mg): 384.62% variation. Conclusion: The average percentage price variation of different brands of the same oral antihypertensive drug manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.
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Background: Cardiologists play the major role in the management of hypertension in Bangladesh. Different classes of antihypertensive drugs are being used by the cardiologists in initiating hypertension treatment depending on the age and gender of the patient, severity of hypertension and associated diseases. However, there is no particular study to evaluate the patterns of the utilization of these antihypertensive drugs. Again, it is very important to use the right antihypertensive drug for the right patient to move further ahead in the management of hypertension. Hence, the current use of antihypertensive drugs in initiating hypertension treatment was analyzed. Methods: This was a nationwide survey with a participation of 196 cardiologists. Individual opinions from these cardiologists were collected through a questionnaire asking which antihypertensive they use most in initiating hypertension treatment. Collected data were analyzed by SPSS 17 software. Results: ACEI mono-therapy is the mostly used antihypertensive drug class for male patients aged < 55 years having mild to moderate hypertension. CCB mono-therapy is the mostly used antihypertensive drug class for female patients aged < 55 years having mild to moderate hypertension. CCB mono-therapy is also the mostly used antihypertensive drug class for both male and female patients aged e” 55 years having mild to moderate hypertension. For severe hypertensive patients aged < 55 years, the mostly used antihypertensive drugs are combinations of ACEI+CCB+D for both male and females. For severe hypertensive patients aged e” 55 years, the mostly used antihypertensive drugs are combinations of ACEI+CCB+D for males and combinations of CCB+BB for females. However, the overall pattern of using antihypertensive drugs did not significantly vary between male and female patients. Conclusion: The pattern of using antihypertensive drugs varies depending on age and gender of the patient and on the severity of hypertension. But, the overall pattern of using antihypertensive drugs did not significantly vary between male and female patients.
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Cardiovascular diseases (CVDs) are the major contributors to the global burden of chronic diseases. In India CVD is projected to be the largest cause of death and disability by 2020. Hypertension is the commonest CVD affecting at least 20% of adult population. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. The prevalence of CVD in the state of Kerala was found in the cross section of the society by the research group in an earlier study on prevalence of hypertension. A plethora of new drugs are now available and the quality of life for these patients has considerably improved. In the present investigation, the prescribing attitude of various physicians was reviewed carefully. The available medical records and the prescriptions of the Cardiology unit were reviewed to study the prescribing pattern and drug therapy for CVD. The various aspects studied were; the diagnosis and preliminary investigations conducted for the patients, Mean Systolic Blood Pressure (SBP), Mean Diastolic Blood Pressure (DBP), the investigation reports of lipid profiles, Mean Total Cholesterol and Mean HDL Cholesterol levels, advises made with regard to other investigations like ECG, TMT, Echo etc and type of drugs prescribed including cases of combination therapy in first visit and subsequent revisits. Prevalence of diabetes was also studied in CVD patients. The prescribing pattern for hypertension reveals that single drug therapy was mostly preferred. The most commonly preferred and prescribed drugs (MCPP) were Amlodipine, Atenolol, and Losartan Potassium etc. However combination therapy (CT) was also observed. The most commonly preferred and prescribed combinations were Atenolol+Amlodipine, Enalapril+Hydrochlorothiazide, Frusemide+Spironolactone. The various classes of drugs include ACE inhibitors, Beta-Blockers, Nitrates, and Diuretics etc. Aspirin was prescribed for 40 to 50% of patients. Despite the proven benefits of Aspirin therapy in the primary and secondary prevention of CVD, the prescribing pattern still remains little suboptimal. The Biochemical investigation reports of the lipid profile reveal that a considerable number of patients were found to have dislipidemia. Statins and Fibrates were mostly prescribed for lowering low density Lipoprotein Cholesterol (LDL-C) and improving High density Lipoprotein Cholesterol (HDL-C) levels. The study reveals that there is a considerable extent of CVD risk factors in the studied cross section of the community.
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Objectives: To assess polypharmacy and patient’s knowledge regarding antihypertensives in Gynaecology and obstetrics department. Materials and Methods: This is a prospective comparative study carried out in Gynecology and Obstetrics department in two tertiary care hospitals. A interaction was done with consultants, post graduate students patients and patient’s attendants and the readings were taken. Results: A total of 200 prescription were studied and the average number of per prescription was 2.47%, poly pharmacy in 122/200, adequate knowledge was in 139/200 patients. Conclusion: The incidence of poly Pharmacy was more in our set of studies, patients compliance/adequate knowledge was good only among educated patients. The concerned health care can be improved by prescribing rational and required prescription and by motivating patients and patient’s attender, regarding the intake of drugs.
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OBJECTIVES: To determine if capillary rarefaction persists when hypertension is treated with angiotensin converting enzyme inhibitor, thiazidic diuretic and/or beta-blocker, and to identify which microcirculatory alterations (structural and functional) persist after anti-hypertensive treatment. METHODS: We evaluated 28 well-controlled essential hypertensive patients and 19 normotensive subjects. Nailfold videocapillaroscopy examination of the fourth finger of the left hand was used to determine the functional capillary densities at baseline, during post-occlusive hyperemia, and after venous congestion. Capillary loop diameters (afferent, apical and efferent) and red blood cell velocity were also quantified. RESULTS: Compared with normotensive subjects, hypertensive patients showed lower mean functional capillary density at baseline (25.1±1.4 vs. 33.9±1.9 cap/mm², p<0.01), during post-occlusive reactive hyperemia (29.3±1.9 vs. 38.2±2.2 cap/mm², p<0.01) and during venous congestion responses (31.4±1.9 vs. 41.1±2.3 cap/mm², p<0.01). Based on the density during venous congestion, the estimated structural capillary deficit was 25.1 percent. Mean capillary diameters were not different at the three local points, but red blood cell velocity at baseline was significantly lower in the hypertensive group (0.98±0.05 vs. 1.17±0.04 mm/s, p<0.05). CONCLUSIONS: Patients treated for essential hypertension showed microvascular rarefaction, regardless of the type of therapy used. In addition, the reduced red blood cell velocity associated with capillary rarefaction might reflect the increased systemic vascular resistance, which is a hallmark of hypertension.
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Female , Humans , Male , Middle Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Capillaries/drug effects , Diuretics/therapeutic use , Hypertension/drug therapy , Microcirculation/drug effects , Nails/blood supply , Antihypertensive Agents/therapeutic use , Blood Flow Velocity/drug effects , Blood Flow Velocity/physiology , Blood Pressure/drug effects , Blood Pressure/physiology , Capillaries/physiopathology , Hypertension/physiopathology , Microcirculation/physiology , Treatment Outcome , Vascular Resistance/drug effects , Vascular Resistance/physiologyABSTRACT
Objective:To analyze the usage of anti-hypertensive drugs in our hospital,and provide a reference for clinical rational drug use.Method:With the consumption sort and DDDs analysis,the consumption of anti-hypertensive drugs used in 2006-2008 was analyzed.Result:The consumption of anti-hypertensive drugs in our hospital increased every year,and the consumption of the angiotensinⅡreceptor blockers(ARB),calcium channel blockers(CCB),angiotensin-converting enzyme inhibitor(ACEI) in three years were the top three of the total drug consumptions.Conclusion:The use of anti-hypertensive drugs was basically rational in our hospital and matched the domestic usage of anti-hypertensive drugs.
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OBJECTIVE:To investigate the feature and tendency of the application of antihypertensive drugs in our hospital.METHODS:The utilization of antihypertensive drugs in our hospital from Jun.2004 to Dec.2006 was analyzed statistically in respect of the consumption sum and DDDs etc.RESULTS:The first line drugs used most frequently in our hospital were beta receptor antagonists,AGT Ⅱ antagonists,ACEI,a calcium antagonist etc.Leading the first place on the list of DDDs was indapamide because of its good safety and efficacy.Mesylate amlodipine,felodipine,irbesartan,perindopril,metoprolol tartrate,indapamide,bisoprolol fumarate,losartan/hydrochlorothiazide ranked among the first 10 places in either DDDs or consumption sum.CONCLUSION:The antihypertensive drugs are characterized by complicated categorization,wide variety,and widespread clinical application,and the use of which in our hospital is basically rational.
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The aim of this study was to elucidate the effects of anti-hypertensive drugs, nifedipine, furosemide, hydrochlorothiazide, captopril, and atenolol on DNA synthesis and proliferation of cultured rat aortic smooth muscle cells induced by fetal calf serum. Aortic smooth muscle cells from Sprague-Dawley rats were isolated, cultured, and seeded in multi-well plates. When confluent, cells were cultured in a conditioned medium without fetal calf serum. After 72 hours, cells were cultured in the medium retaining 10% fetal calf serum with or without anti-hypertensive drugs by increasing the concentration between 10(-8) and 10(-4) M. DNA synthesis was assessed by [3H]-thymidine uptake and proliferation by cell numbers using a hemocytometer. Nifedipine at a concentration of 10(-5) M and 5 x 10(-5) M inhibited serum-induced DNA synthesis significantly by 50.8% and 86.6%, respectively (p < 0.05). The results of cell numbers paralleled those of 3H-thymidine incorporation. Serum-induced DNA synthesis was also reduced by 32.6% at the highest dose of furosemide (10(-4) M), but there was no statistical significance. Hydrochlorothiazide, captopril, and atenolol did not show anti-proliferative effect throughout any of the doses. In conclusion, among the various anti-hypertensive drugs, nifedipine seems to be most beneficial in view of its direct inhibitory effect on DNA synthesis and proliferation of smooth muscle cells, as well as for its anti-hypertensive effect.