Assessment of medication adherence among hypertensive patients in a tertiary care teaching hospital in India

Background: Hypertension is a chronic disorder and a prevalent non-communicable disease in India. With the increasing burden of hypertension, adherence to antihypertensive therapy plays a vital role to control blood pressure and preventing its complications. Therefore, this study was done in our tertiary care hospital to understand the medication adherence level in hypertension patients. Aims and Objectives: To assess adherence to antihypertensive medications in hypertensive patients using pre-tested structured questionnaire. Materials and Methods: A prospective observational study was conducted for 3 months in 100 hypertensive patients. The adherence status of patients to antihypertensive medications was assessed using an eight-item Morisky’s Medication Adherence Scale (MMAS-8). Results: Majority of the study participants in our study were >50 years (68%) and females (64%). We observed that patients taking combination therapy better adhered to medication than monotherapy. We assessed in detail the medication adherence level among study participants using MMAS-8 and analyzed the reasons for non-adherence. Conclusion: The medication adherence rate in our study was found to be moderate to high, which needs to be maintained to attain optimal clinical benefit and also to prevent hypertension-related complications.

Patient’s adherence to antihypertensive drugs in a tertiary care hospital: A cross-sectional study

Background: Hypertension (HTN) is a serious public health problem. Good control of the disease has always been considered to be essential for reducing its morbidity and mortality. Poor adherence to treatment is the single most important reason for uncontrolled blood pressure, serious complications, and wastage of health-care resources. Aims and Objectives: This study aims to assess the antihypertensive medication adherence level among hypertensive study participants, and identify and evaluate the barriers to antihypertensive medication adherence. Materials and Methods: A hospital-based descriptive cross-sectional study was conducted in tertiary care medical college hospital in Madurai, Tamil Nadu, involving 332 patients and the collected data were presented as means (standard deviations) and percentages. Comparison of data was performed using Pearson’s Chi-square test. For all statistical analyses, commercially available computer program was used. Results: Among 332 study participants having age range of 31–78 years with a mean age of 57.49 ± 9.20 years, female (approx. 60%) were more than male (40%) participants. About 96.7% of respondents were aware that HTN could cause severe consequences with regard to their health and daily activity but more than half were taking medium salt (56.0%) and more than one-third (32.8%) were taking fatty rich diet. Only one-fourth (25.6%) had good medication adherence. Male participants (34.8%) were more adherent to medication than female (20.2%) and this was statistically significant with P = 0.003. Conclusion: Around 3/4th of study participants (72.9%) were poorly adherent to antihypertensive medication. Hence, there should be improvement in awareness for both the patients and the care providers.

Psychometric Properties of Trilingual Versions of HBC-HBP HillBone Compliance to High Blood Pressure (9-Items) in Divergent Ethnic Groups of Older Adults in Iran

@#Introduction: The HBC-HBP Scale is the most common scale for measuring adherence to medication in the elderly with hypertension, its Persian version has never been tested in Iran. Methods: 281 older adults with hypertension were randomly selected from health care centers in Iran during the second half-year of 2019. The demographic questionnaire and Persian, Turkmen, and Kazak versions of HBC-HBP were completed by participants. The scale structure was evaluated using goodness of fit by Exploratory and Confirmatory Factor Analysis using IBM-SPSS v.26 and AMOS v.24. Results: The mean of CVI was 0.94, indicating good content validity for HBC-HBP. Exploratory Factor Analysis revealed two subscales for HBC-HBP, collectively explaining 70% of the adherence medication variance in three versions. All item loadings were “moderate” to “excellent”, ranging from 0.38 (Moderate) to 0.95(excellent). Confirmatory Factor Analysis indicated the goodness of fit for the HBC-HBP based on the trilingual version. A high goodness of fit was sown for Turkmen, Persian, and Kazak versions of HBC-HBP. (Chi-Square=8.213, 8.354, 8.210, RMSEA=0.016, 0.013, 0.010, GFI=0.90, 0.90, 0.91, CFI=0.91, 0.90, 0.91, and AGFI=0.90, 0.91, 0.90). Cronbach’s alpha was 0.90 for the whole scale (p<0.001). The optimal cut-off point that best distinguished between adherent and non-adherent patients was 26.5. Conclusion: Results showed the validity and reliability of the trilingual versions of the HBMA for measuring adherence medication in the elderly with hypertension.

Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

Background: Hypertension is a major non-communicable disease and a large proportion of patients are not treated adequately even though several antihypertensive drugs and various guidelines are available. Aims and Objectives: The aim of the study was to study the treatment pattern and effectiveness of the antihypertensive drugs by estimating the blood pressure (BP) control achieved based on Joint National Committee (JNC) 8 guidelines for the treatment of hypertension. Materials and Methods: In this observational study, 92 patients with primary hypertension diagnosed since 1 1/2 years were included in the study. BP at the time of diagnosis and on subsequent follow-up visits and details of antihypertensive drugs prescribed during each visit were recorded, until target BP was achieved or till the end of the study period. Wilcoxon Signed Rank test and Mann–Whitney U test were used for analyzing the dependent and independent groups, respectively. Results: Mean age of patients was 57.50 years and 54.3% of them were females. Majority received single drug (80.43%) compared to combination therapy (19.57%). Most frequently prescribed antihypertensive drug group was angiotensin receptor blockers (47.75%) followed by calcium channel blockers (41.44%) and most commonly prescribed individual drugs were losartan and amlodipine (both 25.22%). Seventy-three (79.30%) patients attained their target BP and the average time taken for the adequate control of BP was 5.67 (S.D ± 2.674) weeks. Conclusion: JNC 8 guidelines were found to be effective in this study population.

A study of chronopharmacological relevance of antihypertensive drugs prescription

Background: Chronopharmacology is the 搒cience dealing with the optimization of drug effects and minimization of adverse effects by timing the medications in relation to the biological rhythm.� In patients with hypertension, it is important to maintain a steady blood pressure throughout the day, which necessitates to have knowledge of chronopharmacology and drugs following it. Better understanding of the circadian rhythm and its application for drug administration serves productive utilization of drug. Aims and Objectives: This study aims to study the chronopharmacological relevance to the time of drug administration in general medicine inpatients at Gulbarga Institute of Medical Sciences, Kalaburagi. Materials and Methods: It is a prospective, non-interventional, observational study which was conducted on patients admitted in General Medicine wards at GIMS, Kalaburagi. A special pro forma was designed, and data were obtained from medical case records of patients suffering from various disorders admitted in the wards of general medicine. Demographic data, disease data, data pertaining to drug therapy, data pertaining to other comorbid illness, and adverse effects of drugs, if any, were collected. Descriptive statistics and other suitable statistical test were applied for analyzing the data. Results: A total of 110 patients who were on antihypertensive drugs and who meet the inclusion and exclusion criteria of the study were included in the study. The average age of both male and female was found to be between 45 and 68 years. Among 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. In the current study, a total of 124 wide variety of antihypertensive drugs were recorded. The study of ideal time of administration of all antihypertensive drugs showed that, most of the prescription was according to chronopharmacological relevance. Conclusion: Updating the knowledge of chronopharmacology and its application in clinical practice will provide better health care. The current study highlights the importance of timing of administration of antihypertensive drugs in human health care.

HIPERTENSÃO E DIABETES: CONCEITOS ATUAIS NA TERAPÊUTICA / HYPERTENSION AND DIABETES: CURRENT CONCEPTS IN THERAPEUTICS

Diabetes mellitus tipo 2 (DM) cursa com alta prevalência na população, acometendo cerca de 9,3% da população mundial (463 milhões de indivíduos). Devido ao crescimento dos casos e envelhecimento populacional, estima-se que o número de diabéticos será superior a 628 milhões em 2045. Dados de 2013 estimam que 6,2% da população brasileira acima dos 18 anos de idade tenham diabetes. Rápida urbanização, transição epidemiológica, fator nutricional, estilo de vida sedentário, excesso de peso, crescimento e envelhecimento populacional são fatores associados ao aumento da prevalência. Geralmente, ao tempo do diagnóstico do DM, a hipertensão arterial sistêmica (HAS) está presente em 50% dos diabéticos. O artigo discute aspectos relacionados à fisiopatogenia do diabetes e hipertensão, as metas de pressão arterial e as principais abordagens terapêuticas no tratamento da hipertensão arterial no paciente diabético, de acordo com as diretrizes mais recentes

Type 2 Diabetes mellitus presents high prevalence in the population, responding for about 9.3% in the world population (463 million individuals). Due to cases increase and aging, it is estimated that the number of diabetic subjects will be higher than 628 million in 2045. Data of 2013 show that 6,2% of Brazilian population higher 18 years-old have diabetes. Fast urbanization, epidemiological transition, nutritional factor, physical inactivity, overweight, population growth and aging are factors associated to increase of prevalence. Generally, when of diabetes diagnosis, hypertension is present in 50% of diabetic individuals. The article discusses aspects of pathophysiology of hypertension and diabetes, the targets of blood pressure and the principal therapeutic approaches of treatment of hypertension in the diabetic patient, in according to recenter guidelines

Adherencia terapéutica en pacientes hipertensos de un consultorio médico perteneciente al Policlínico Universitario "Joaquín de Agüero y Agüero" / Adherence to treatment in hypertansive patients from a local primary care office linked to the Policlínico Universitario "Joaquín de Agüero y Agüero" / Adesão terapêutica em hipertensos atendidos em consultório médico da Policlínica Universitária "Joaquín de Agüero y Agüero"

RESUMEN Introducción: La medicación antihipertensiva de pacientes mayores de 20 años amerita un riguroso control, que garantice un adecuado mantenimiento del estado de salud de dicho grupo poblacional. Objetivo: Analizar la adherencia terapéutica en los pacientes con hipertensión arterial del Consultorio del Médico de Familia No. 4, perteneciente al Policlínico Universitario "Joaquín de Agüero y Agüero", del municipio Camagüey. Método: Estudio observacional, descriptivo de corte transversal durante el periodo de octubre de 2020 a febrero de 2021. Se trabajó con los 98 pacientes de 20 y más años de edad, con dificultad en su control de la tensión arterial debido al incumplimiento de su tratamiento. Se midieron las variables: edad, sexo, grado de hipertensión, adherencia al tratamiento a través del test de Morisky-Green-Levine, cantidad de fármacos utilizados y los factores de la no adherencia. La información se procesó a través del paquete estadístico SPSS 25.0. Resultados: Existió un predominio de los mayores de 60 años (46,9 %), del sexo masculino en un 58,1 %, clasificados como grupo II de la hipertensión arterial (51 %). Predominaron los pacientes con una adherencia parcial terapéutica (68,3 %) según el test de Morisky-Green-Levine y con la utilización de tres fármacos como tratamiento de la enfermedad (46,9 %). Dentro de los factores más frecuentes predominaron la dificultad con la obtención del medicamento (86,7 %) y la realización de la dieta (77,5 %). Conclusiones: La no adherencia terapéutica en los pacientes hipertensos los expone a la aparición de complicaciones cardiovasculares, con la repercusión que conlleva para el individuo, la familia y la sociedad.

ABSTRACT Introduction: The antihypertensive treatment in patients with 20 or more years old requires strict controls in order to maintain their healthy life span. Objective: To assess the therapeutic adherence in patients with hypertension from the Family doctor's office No. 4, linked to the Policlínico Universitario "Joaquín de Agüero y Agüero", in Camagüey. Method: An observational, descriptive, cross-sectional study during the period from October 2020 to February 2021 was conducted. In the research 98 patients with 20 or more years old were recruited to work with. Patients with difficulties in their blood pressure control due to the noncompliance with the treatment. Variables assesed were as follow: age, sex, stage of hypertension, adherence to treatment using the Morisky-Green-Levine test, drugs used, and non-adherence factors. The information gathered was processed via SPSS statistic 25.0. Results: Patients with 60 years old (46.9%), males (58.1%), and clasified as stage 2 hypertension (51%) were predominant. Also, were predominant patients with partial therapeutic adherence (68.3%) (asper the Morisky-Green-Levine test outcomes), and patients whitch used three types of drugs to treat the illness (46.9%). The most common factors found were lack of drugs to treat the hypertension (86.7%) and the inadequate diet (77.5%). Conclusions: Non-adherence to treatment in hypertensive patients expose them to adquire any cardiovascular complication, aspect whitch affect patients themselve, family, and the society.

RESUMO Introdução: A medicação anti-hipertensiva em pacientes com mais de 20 anos exige um controle rigoroso, o que garante uma manutenção adequada do estado de saúde desse grupo populacional. Objetivo: analisar a adesão terapêutica em pacientes com hipertensão arterial no Consultório Médico de Família nº 4, pertencente à Policlínica Universitária "Joaquín de Agüero y Agüero", do município de Camagüey. Método: Estudo observacional, transversal, descritivo, de outubro de 2020 a fevereiro de 2021. Trabalhamos com 98 pacientes com idade igual ou superior a 20 anos, com dificuldade de controle da pressão arterial devido à não adesão ao tratamento. As variáveis foram mensuradas: idade, sexo, grau de hipertensão, adesão ao tratamento pelo teste de Morisky-Green-Levine, quantidade de medicamentos utilizados e fatores de não adesão. As informações foram processadas por meio do pacote estatístico SPSS 25.0. Resultados: Houve predomínio dos maiores de 60 anos (46,9%), 58,1% do sexo masculino, classificados como grupo II de hipertensão arterial (51%). Predominaram pacientes com adesão terapêutica parcial (68,3%) pelo teste de Morisky-Green-Levine e com uso de três medicamentos para tratamento da doença (46,9%). Dentre os fatores mais frequentes, predominou a dificuldade de obtenção do medicamento (86,7%) e da dieta alimentar (77,5%). Conclusões: A não adesão terapêutica em hipertensos os expõe ao aparecimento de complicações cardiovasculares, com as repercussões que isso acarreta para o indivíduo, a família e a sociedade.

Hipertensão resistente: análise dos estudos pathway 2 e 3 / Resistant hypertension: analysis of pathway 2 and 3 studies

A hipertensão arterial resistente (HAR) é definida quando, apesar do tratamento com pelo menos três medicações anti- -hipertensivas (incluindo um diurético) de diferentes classes a meta pressórica não é alcançada. Nesta sequência de fármacos, por muitos anos se utilizou empiricamente ou baseado em pequenos estudos, a espironolactona. Os estudos Pathway 2 e 3 vieram para corroborar a importância deste quarto fármaco, a espironolactona, como o mais eficaz em termos de potencia anti-hipertensiva, como também explicar os aspectos fisiopatológicos que levam o hipertenso a ficar resistente. Nesta revisão e análise crítica dos fármacos anti-hipertensivos na HAR destacamos os principais mecanismos envolvidos no não controle da pressão e as estratégias para um melhor controle pressórico

Resistant arterial hypertension (RAH) is defined when, despite treatment with at least three antihypertensive medications (including a diuretic) of different classes, the pressure target is not achieved. In this sequence of drugs, for many years it was used empirically or based on small studies, spironolactone. Pathway 2 and 3 studies have come to corroborate the importance of this fourth drug, spironolactone, as the most effective in terms of antihypertensive potency, as well explain the pathophysiological aspects that lead hypertensive patients to become resistant. In this review and critical analysis of antihypertensive drugs in hypertension, we highlight the main mechanisms involved in the lack of pressure control and the strategies for better pressure control

Construção e validação de recursos audiovisuais para motivar pessoas com hipertensão ao uso de anti-hipertensivos / Construcción y validación de recursos audiovisuales para motivar a las personas con hipertensión para utilizar antihipertensivos / Construction and validation of audiovisual resources to motivate people with hypertension to use antihypertensives

Resumo Objetivo Construir e validar comunicação audiovisual e mensagens persuasivas para motivar o uso de anti-hipertensivos. Método Estudo metodológico baseado nas crenças de pessoas com hipertensão arterial sistêmica em relação ao tratamento medicamentoso, tendo o suporte da Teoria do Comportamento Planejado. Adotaram-se os princípios de Fleming e da Persuasão para desenvolvimento da comunicação audiovisual e mensagens. 13 juízes especialistas realizaram a validação de conteúdo, analisada pelo Índice de Validade de Conteúdo. Resultados A comunicação audiovisual apresenta 3 minutos e 58 segundos de duração e 71 telas. Foram consideradas válidas 29 mensagens persuasivas ilustradas, sendo 15 positivas e 14 negativas. Conclusão e implicações para a prática A comunicação audiovisual e as mensagens persuasivas foram consideradas válidas, adequadas e com capacidade de persuasão para motivar o uso de anti-hipertensivos orais. Pesquisa de intervenção faz-se necessária para testar o efeito dos recursos audiovisuais com intenção de realizar o comportamento.

Resumen Objetivo Construir y validar la comunicación audiovisual y los mensajes persuasivos para motivar el uso de antihipertensivos. Método Estudio metodológico basado en las creencias de las personas con hipertensión arterial sistémica en relación con el tratamiento farmacológico, apoyado por la Teoría del Comportamiento Planificado. Los principios de Fleming y la Persuasión fueron adoptados para el desarrollo de la comunicación y los mensajes audiovisuales. 13 jueces expertos realizaron la validación del contenido, analizada por el Índice de Validez del Contenido. Resultados La comunicación audiovisual tiene 3 minutos y 58 segundos de duración y 71 pantallas. Se consideraron válidos 29 mensajes ilustrativos persuasivos, 15 mensajes eran positivos y 14 negativos. Conclusión e implicaciones para la práctica La comunicación audiovisual y los mensajes persuasivos se consideraron válidos, adecuados y capaces de persuadir para motivar el uso de antihipertensivos orales. La investigación de intervención es necesaria para probar el efecto de los recursos audiovisuales con la intención de llevar a cabo el comportamiento.

Abstract Objective Building and validating audiovisual communication and persuasive messages to motivate the use of antihypertensive drugs. Method Methodological study based on the beliefs of people with systemic arterial hypertension in relation to drug treatment, supported by the Theory of Planned Behavior. The principles of Fleming and Persuasion were adopted for the development of audiovisual communication and messages. 13 expert judges performed the content validation, analyzed by the Content Validity Index. Results the audiovisual communication has 3 minutes and 58 seconds in duration and 71 screens. Twenty-nine persuasive illustrated messages were considered valid, 15 positive and 14 negative messages. Conclusion and implications for practice Audiovisual communication and persuasive messages were considered valid, adequate and capable of persuasion to motivate the use of oral antihypertensives. Intervention research is necessary to test the effect of audiovisual resources with the intention of carrying out the behavior.

Clevidipine as an antihypertensive drug in three pheochromocytoma surgeries: Case series / Clevidipino como fármaco antihipertensivo en tres cirugías de feocromocitoma: Serie de casos

Abstract Introduction Laparoscopic adrenalectomy is the treatment of choice of pheochromocytoma. During the first surgical phase (pneumoperitoneum insufflation, tumor and veins handling), there is a risk of hypertensive crisis due to catecholamine release. After tumor excision, patients can suffer relative vasodilation and the residual effect of antihypertensive drugs, which results in arterial hypotension. For that reason, antihypertensive drugs used in the first phase should have a rapid onset of action, short half-life and no residual effect. Methods We report a series of three cases of patients with pheochromocytoma who were treated with laparoscopic adrenalectomy. They all received clevidipine infusion from the beginning of the surgery, before they had presented hypertension, to treat and try to minimize hypertensive peaks. Results In all patients, hypertensive peaks were controlled in a few minutes. After tumor resection, clevidipine infusion was stopped in all cases, and any patient required infusion of vasopressors. Discussion Clevidipine could be a first choice antihypertensive drug in pheochromocytoma surgery. Starting the infusion of clevidipine before the hypertensive peaks could help to make them less pronounced.

Resumen Introducción La adrenalectomía laparoscópica es el tratamiento de elección del feocromocitoma. Durante la primera fase quirúrgica (insuflación de neumoperitoneo, manipulación del tumor y de las venas implicadas), existe el riesgo de que se desencadenen crisis hipertensivas debido a la liberación de catecolaminas. Después de la extirpación del tumor, los pacientes pueden sufrir una vasodilatación relativa y el efecto residual de los fármacos antihipertensivos usados previamente, lo que resulta en hipotensión arterial. Por esa razón, los fármacos antihipertensivos utilizados en la primera fase quirúrgica deben tener rápido inicio de acción, vida media corta y mínimo efecto residual. Métodos Se describe una serie de casos de tres pacientes con feocromocitoma que fueron tratados con adrenalectomía laparoscópica. Todos recibieron infusión de clevidipino desde el comienzo de la cirugía, antes de presentar hipertensión arterial, para así intentar minimizar y tratar rápidamente los posibles picos hipertensivos. Resultados En todos los pacientes los picos hipertensivos se controlaron en pocos minutos. Después de la resección del tumor, la infusión de clevidipino se detuvo en todos los casos y ningún paciente requirió perfusión de vasopresores. Discusión El clevidipino podría ser un fármaco antihipertensivo de primera elección en la cirugía de feocromocitoma. Iniciarlo antes de que ocurran los picos hipertensivos podría ayudar a que sean más leves.

Respuesta de los sujetos con hipertensión arterial a los fármacos antiagregantes plaquetarios / Response of hypertensive subjects to antiplatelet drugs

Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares. Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios. Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria. Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 por ciento óptima y 42,9 por ciento moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 por ciento óptima y 26,5 por ciento moderada) y los no hipertensos (30,2 por ciento óptima y 30,2 por ciento moderada). Además, se encontró que 17,7 por ciento de los sujetos no hipertensos, 14,3 por ciento de los hipertensos sin fármacos antihipertensivos y 13,2 por ciento de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios. Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos(AU)

ABSTRACT Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events. Objective: To evaluate the response of hypertensive patients to antiplatelet drugs. Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation. Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 percent good and 42,9 percent moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 percent good and 26,5 percent moderate) and the non-hypertensive ones (30,2 percent good and 30,2 percent moderate).Besides, it was found that 17,7 percent of non-hypertensive subjects and 14,3 percent of the hypertensive ones without antihypertensive drugs and 13,2 percent of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs. Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects(AU)

A study on drug utilization pattern of antihypertensive drugs in hypertensive diabetic patients

Background: Hypertension management is of paramount importance in diabetic patients for reduction of cardiovascular and other complications. The objective of the present study was to assess prescribing pattern of antihypertensive drugs in hypertensive type 2 diabetic patients and evaluate them by comparing with Eighth Joint National Committee (JNC-8) hypertension treatment guidelines.Methods: A prospective observational study was carried out on 110 hypertensive type 2 diabetic patients of age 41-80 years visiting outpatient department of Medicine at G.S. Medical College and Hospital, UP, India for 4 months. JNC-8 hypertension management guideline was considered while evaluating the prescribed drugs. All the relevant data was collected from the prescription card of the patient on a preformed performa and analyzed using descriptive statistics.Results: Total of 176 drugs was prescribed to the study patients among which two drug combination therapy (55.45%) was mostly used. The most common group prescribed was angiotensin receptor blocker (ARB) (29.45%) and ARB+CCB (calcium channel blockers) (34.92%) were the commonest fixed drug combination. Overall, it was amlodipine (21.47%) that was most frequently prescribed among all antihypertensive drugs.Conclusions: ARB was the most commonest class, ARB+CCB was the most frequent fixed drug combination prescribed to the study patient while amlodipine was the highly utilized individual antihypertensive drug in the study. Prescriptions evaluation revealed that 94.88% prescription were rational and were in accordance with the JNC-8 hypertension treatment guidelines except the use of beta blockers (5.12%).

An observational study on the prescription pattern of antihypertensive drugs in a private health care centre, Chennai

Background: Hypertension is a public health problem worldwide. Elevated systolic blood pressure ?140 mm Hg or diastolic blood pressure ?90 mmHg are defined as Hypertension. The choice of an antihypertensive drug is based on its efficacy, side-effects, effects on other systems and cost. The objective of this study is to evaluate the prescription pattern of antihypertensive drugs in a private health care centre.Methods: A retrospective observational study was carried out in the out-patient department of a private health care centre, Chennai from November 2018 to December 2018.Results: In the present study, 104 prescriptions were selected based on the inclusion criteria. In which 62 (59.61%) were males and 42 (40.38%) were females. Prescriptions belonging to age group of <40 years were 11 (10.57%), 40–59 years were 48 (46.15%) and >60 years were 45 (43.26%). Monotherapy was received by 62 hypertensive patients and as combination therapy by 42 patients.Conclusions: Even though the prescription pattern of antihypertensive drugs in this study complied with the recommended guidelines, clinicians should always be vigilant and consider change of regimen whenever necessary.

Study of Prescription Pattern of Antihypertensive Drugs in Medical OPD in SGT Medical College and Hospital, Gurugram

Objectives: Present study was conducted to find out currenttrend of drug prescribing of antihypertensive drugs prescribedeither as monotherapy or in combinations. As well as variationswere seen in prescribing drugs with regards to the age, sex.Materials & Methods: An observational, prospective, crosssectional study involving 120 prescriptions for patients ofessential hypertension was conducted in the outpatientdepartment of Medicine SGT Medical Hospital, Faculty ofMedicine and Health Sciences, Gurugram. The blood pressure(BP) measurement was done at the time of enrolment andother patient information like demographics and the drugdetails were recorded in Performa sheet. Data obtained wereanalyzed and expressed in percentage.Results: 71 males and 49 female of essential hypertensionpatients were included in study. Most of patients were in theage group of 40 -49 years constituting 72.5 % of total 120patients. 52 patients were on mono therapy 64 (53%) ofpatents were put on Dual therapy and few patients 4 (3.33%)were on Triple therapy. Out of 52 patients those were on monotherapy maximum patients were put on angiotensin receptorblocker (38.46%) and 11.54% of patients were takingAngiotensin converting enzyme inhibitor. 64 patients wereprescribed with Dual therapy. Out of these 46.9% of patientswere prescribed with ARB + Diuretics and nearly 2% patientswere on ARB + β blocker combination therapy. Only fourpatients were taking Triple therapy, 50% of patients were onCCB + ARB + Diuretics and 50% were on CCB + ACEI +Diuretics.Conclusions: Hypertension is more prevalent in male patientsthan female patients. ARBs (38.46%) were the most commonsingle drugs used for most of the uncomplicated essentialhypertension followed by CCBs (36.54%) ARB prescription asmonotherapy may be increases because of few or minimal sideeffects caused by them. Most common mode of treatment ofhypertension was Dual therapy or triple therapy combinationtherapy fixed dose combinations (56%). In the FDCs ARB +Diuretics (48%) were most preferred combination for treatmentof hypertension then CCB + β blocker (30%) and only 9% ofpatients were treated on ACEI based FDCs. Only 44% ofpatients were prescribed with drugs mentioned in the nationallist of essential medicine (NLEM). Prescribing drug from NLEMshould be encouraged to reduce the burden of treatment coston the patients. ARB were the most preferred drug for thetreatment of hypertension may be because of low toxicity andfewer side effect, easily available in the market.

A study of the cost analysis of various oral antihypertensive drugs available in Indian market

Background: Hypertension is a serious global public health problem. It accounts for 10% of all deaths in India and is the leading non-communicable disease. Recent studies have shown that the prevalence of hypertension is 25% in urban and 10% in rural people in India. It exerts a substantial public health burden on cardiovascular health status and health care systems in India. Antihypertensive treatment effectively reduces hypertension related morbidity and mortality. The cost of medications has always been a barrier to effective treatment. The increasing prevalence of hypertension requires use of cost effective treatment for the effective management of the disease.Methods: Cost of a particular drug (cost per 10 tablets) in the same strength and dosage forms being manufactured by different companies was obtained from Current Index of Medical Specialties, Jan?April 2019 and “Indian Drug Review” (IDR) September 2018. Difference between the maximum and minimum cost of the same drug manufactured by different pharmaceutical companies was calculated and percentage cost variation was calculated.Results: The prices of a total of 24 drugs (15 single and 9 combination preparations), available in 59 different formulations were analysed. These 62 formulations are manufactured by different pharmaceutical companies.Conclusions: 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.

Study of prescribing pattern of antihypertensive drugs in diabetic patients in a tertiary care centre, Vizianagaram, India

Background: Diabetes mellitus (DM) and Hypertension (HTN) are the two major chronic disorders frequently coexisting, with increased incidence with age. HTN is about twice as common in patients with DM. Prescribing pattern are powerful tools to ascertain the role of drugs in society. There are many variations in prescribing patterns of antihypertensive drugs in patients with HTN and DM. Since these patients requires lifelong treatment it has enormously increased the burden of patients particularly in developing countries like India. Physician needs to be more concerned while choosing drugs for the patients with HTN and DM. In a tertiary care hospital, there is a real need for drug utilization study to determine the appropriate, more safe and effective patterns of drug therapy among diabetic hypertensive patients.Methods: A Cross sectional observational study was conducted in Maharajah’s Institute of Medical Sciences from December 2016 to May 2018. A total of 360 prescriptions of the patients with hypertension and coexisting diabetes were analyzed. The prescriptions prescribed to these patients were collected, assessed and the following parameters were noted. The treatment pattern of different group of drugs for HTN with co-existing DM was evaluated. The intended work was divided into three steps: Step 1: To collect the prescriptions of hypertensive patients with DM. Step 2: To separate the prescriptions prescribing anti hypertensive Drugs. Step 3: To statistically analyze the prescriptions. Relevant information was recorded in a structured proforma & data was evaluated.Results: In this study it was found that 36% of the patients were in the age group of 51-60 years with female preponderance among diabetic hypertensive patients. 77% of patients were treated with single antihypertensive drug and 23% of patients were treated with antihypertensive drug combinations. In monotherapy, telmisartan was most commonly prescribed. In combination therapy, amlodipine and telmisartan followed by amlodipine and atenolol were used.Conclusions: In this study monotherapy was preferred compared to combination therapy and adherence to the JNC 7 guidelines was good except in case of usage of diuretics.

Control adecuado de la presión arterial en adultos con medicación antihipertensiva de dos Unidades de Salud Familiar de Luque y Fernando de la Mora, Paraguay, 2018

RESUMEN Introducción: la reducción de la presión arterial es una meta en el tratamiento de la hipertensión arterial primaria. Objetivos: determinar la frecuencia de control adecuado de la hipertensión arterial en adultos en tratamiento antihipertensivo de las Unidades de Salud Familiar de Luque y Fernando de la Mora, Paraguay. Metodología: estudio observacional, transversal, prospectivo, con componentes analíticos realizado en pacientes adultos hipertensos tratados en dos Unidades de Salud Familiar durante agosto y septiembre 2018. Se evaluaron variables sociodemográficas y clínicas. Se consideró presión arterial adecuada a todo valor <140/90 mm Hg. Resultados: se incluyeron 149 sujetos, con edad media 60±12 años, 68% del sexo femenino, 42% con sobrepeso-obesidad, 32% eran portadores de diabetes mellitus. Todos recibían tratamiento farmacológico antihipertensivo. El control adecuado de la hipertensión arterial se observó en 55%. Conclusiones: el control adecuado de la hipertensión arterial en pacientes adultos de dos Unidades de Salud Familiar fue 55%. Los antihipertensivos más usados fueron los inhibidores de enzima convertidora de angiotensina y los antagonistas de los receptores de angiotensina II.

ABSTRACT Introduction: The reduction of blood pressure is a goal in the treatment of primary arterial hypertension. Objectives: To determine the frequency of adequate control of arterial hypertension in adults under antihypertensive treatment at the Family Health Units of Luque and Fernando de la Mora, Paraguay. Methodology: Observational, cross-sectional, prospective study with analytical components performed in adult hypertensive patients treated in two Family Health Units during August and September 2018. Sociodemographic and clinical variables were evaluated. Adequate blood pressure was considered at any value <140/90 mm Hg. Results: One hundred forty nine subjects were included, with a average age of 60±12 years, 68% were women, 42% with overweight-obesity, and 32% were carriers of diabetes mellitus. All were receiving antihypertensive drug treatment. Adequate control of arterial hypertension was observed in 55%. Conclusions: The adequate control of hypertension in adult patients of two Family Health Units was 55%. The most commonly used antihypertensives were angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.

Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2)

RESUMEN Se presenta la segunda parte de las recomendaciones latinoamericanas para el manejo de la Hipertensión Arterial (HTA) en adultos. En una primera fase se han descripto los aspectos más relevantes de la epidemiología, aspectos fisiopatológicos, cómo hacer diagnóstico, pautas terapéuticas, urgencias y emergencias hipertensivas, poblaciones especiales, hipertensión refractaria y la aplicación de las guías en la vida real. En esta segunda parte, se emiten recomendaciones respondiendo a preguntas específicas para prevención primaria, secundaria, terciaria y cuaternaria. En general pocas recomendaciones al respecto del manejo de la hipertensión arterial surgen desde la clínica médica/ medicina interna, a pesar de dos situaciones: la mayoría de los pacientes con hipertensión arterial son evaluados y manejados por los clínicos, y la clínica médica es la especialidad que permite la mirada holística e integrada de los problemas de salud del adulto, permitiendo agregar el enfoque biográfico al biológico, comprender e interpretar no solo el problema de salud sino sus causas y consecuencias (que muchas veces suelen corresponder a diferentes parénquimas, lo cual en el modelo fragmentado haría transitar al paciente por distintas especialidades). El bajo porcentaje de pacientes hipertensos controlados obliga a todos los profesionales involucrados en el manejo de los mismos a optimizar recursos y detectar problemas que se asocien a un control deficitario como la sub utilización del tratamiento farmacológico, baja tasa de pacientes tratados con estrategia combinada (la mayoría de los pacientes actualmente recibe monoterapia), falta de prescripción adecuada de los cambios en el estilo de vida, baja adherencia terapéutica e inercia clínica. En la presente publicación se presentan recomendaciones efectuadas por especialistas en clínica médica / medicina interna para el manejo de la hipertensión arterial en adultos, respondiendo preguntas de prevención primaria, secundaria, terciaria, y cuaternaria.

ABSTRACT The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

Open label case control prospective study to evaluate the impact of aceclofenac on antihypertensive action of amlodipine and ramipril in hypertensive patients with osteoarthritis

Objective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study. Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine. Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure. Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers.

Drug utilization study of antihypertensive drugs and prevalence of blood pressure control in adult hypertensive patients based on JNC VIII guidelines in a tertiary care hospital: a cross sectional study

Background: Hypertension is a major independent risk factor for coronary artery disease, congestive heart failure, stroke, chronic kidney disease and peripheral vascular diseases if left untreated. Drug utilization study of antihypertensive drugs and the study on prevalence of blood pressure control would help in reducing the burden of the disease and health expenditure.Methods: The study was conducted in the Outpatient Department of Medicine in Government Medical College, Thrissur. Patients aged 18yrs or above diagnosed with hypertension, on antihypertensive drugs were enrolled in the study. Patients suffering from secondary hypertension and acutely ill were excluded. Patients were enrolled after taking an informed consent. Demographic data, present treatment for hypertension, associated co- morbid conditions if any, and treatment of the same were recorded. BP was recorded, and cost of treatment was calculated using CIMS.Results: A total of 250 patients were included in the study. Mono therapy was used in 64.8% patients and combination therapy in 35.2%. Overall drug utilization pattern showed that CCBs (42.8%) were most commonly prescribed, followed by ACEIs (32.4%) and ARBs (29.2%). Most commonly prescribed combination therapy was ACE I + BB (29.3%), followed by ARB + CCB (21.3%). Mean cost of antihypertensive drug therapy was 3057.8 Rs / yr. Recommended target BP was achieved in 49.6% of patients.Conclusions: The prescription pattern of antihypertensive drug was in accordance to the JNC-VIII guidelines. The blood pressure target was achieved only in less than 50% of patients.