A study evaluating knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives.

Background: The aim of this study was to evaluate knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives and find out the disparity between the recommended and actual practices for pharmacological management. Methods: It was survey type of study, carried out using feedback questionnaire related to use of antihypertensives. Total 25 consultants were included in the study. Results: It was found that in mild hypertension single drug and two drugs in combination were preferred by 15 and 10 practitioners respectively. In moderate hypertension single drug, two drugs in combination, and greater than two drugs were preferred by 3, 13, and 7 practitioners respectively. In severe hypertension two drugs in combination and greater than two drugs were preferred by 16 and 9 practitioners respectively; none preferred single drug. Angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, Calcium channel blockers, diuretics were preferred as first line drug by 7, 4, 8, and 16 practitioners respectively. Most commonly preferred combination was Losartan and amlodipine by 16 practitioners. In pregnancy nifedipine was preferred as the first line drug while in elderly diuretics were preferred. In hypertensive patients with age less than 40 years all practitioners preferred ACEIs/ARBs. In diabetics ACEIs/ARBs was preferred by all practitioners. Each practitioner claimed to follow Joint National Committee (JNC) 7 criteria. Cost of drug was an important consideration in all their prescribing patterns. Conclusion: The knowledge, attitudes and practices followed by the practitioners of Dhiraj hospital were satisfactory and guidelines oriented.

An open-label, prospective study comparing efficacy, tolerability and cost of therapy of losartan with enalapril in stage 1 and stage 2 hypertension.

Background: Hypertension is a chronic disease which insidiously affects multiple systems in the body especially the cardiovascular and cerebrovascular systems. Also being a chronic disease the patient is required to take medications lifelong and this has financial implications. This study was attempted to evaluate drugs in two antihypertensive groups: Angiotensin II antagonist losartan v/s angiotensin converting enzyme inhibitor enalapril. Methods: A total of 100 patients as per the selection criteria were enrolled in the study and allocated randomly to either group A (losartan group) or group B (enalapril group). The study period was for 12 weeks, during which regular assessments were done - first on recruitment and then at 2nd week, 4th week, 8th week, and 12th week. The assessment parameters were diastolic, systolic pressures and pulse rate. Routine investigations were performed during the 1st visit and after 12 weeks of the study period. Results: There were no significant differences between the treatment groups with respect to baseline patient demographic data and clinical characteristics like systolic blood pressure, diastolic blood pressure and heart rate. The cost benefit ratio and less adverse effects (cough), can be appreciated in group A (losartan group). Conclusions: Losartan and enalapril were well tolerated after 12 weeks of treatment with notable tolerability advantages of losartan especially with respect to the respiratory system (cough). The cost of therapy for losartan group was almost half the cost of therapy for enalapril group and hence being cost effective. Thus, losartan could be preferred as a suitable alternative to enalapril as an antihypertensive agent.