Analysis of prescription pattern of antihypertensive medication and adherence to Beers criteria in geriatric department of a tertiary care hospital in Mysuru

Background: The objective of the present study was to evaluate the prescription pattern of anti-hypertensive drugs and adherence to Beers’ criteria in geriatric department of JSS Hospital, Mysuru.Methods: An observational, prospective, cross-sectional study was carried out in geriatric department. The basic demographic information and prescriptions of geriatric patients were studied. Descriptive analysis was used to present the results, prescriptions were analysed and checked for adherence to Beers’ criteria.Results: Out of 485 patients, 82.68% received monotherapy, 15.87% received 2-drug combination therapy and 1.4% received 3-drug combination therapy. Among patients receiving monotherapy, angiotensin receptor blockers (49.06%) was the commonest antihypertensive class of drug prescribed. Telmisartan (38.96%) was the commonest drug prescribed. Among 2-drug combination therapy angiotensin converting enzyme inhibitor and Calcium channel blockers were combined commonly. In 3-drug combination therapy angiotensin converting enzyme inhibitor, beta blockers and diuretics were combined commonly. 99.3% of prescriptions were adhered to 2015 American Geriatrics Society Beers criteria.Conclusions: Almost 82% of the patients were treated with monotherapy. The trends in prescribing of anti-hypertensives were in favor of conventional ones such as Angiotensin receptor blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, diuretics, beta blockers and centrally acting alpha agonists. 99.3% of prescriptions were in accordance with the American Geriatrics Society 2015 Updated Beers criteria.

White-Coat Hypertension: the Neglected Subgroup in Hypertension

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.

Perfil do paciente hipertenso atendido em pronto-socorro: comparação com hipertensos em tratamento ambulatorial / Hypertensive patient´s profile seen in first-aid unit: comparison with hypertensives under ambulatory treatment

Os pacientes hipertensos muitas vezes não realizam o tratamento corretamente levando à falta de controle da doença e atendimentos em unidade de emergência. O objetivo deste estudo foi descrever e comparar o perfil de hipertensos atendidos em pronto socorro com aqueles seguidos em ambulatório quanto a características biossociais, hábitos de vida, conhecimento sobre a doença, tratamento e níveis de pressão arterial. Foram entrevistados 100 hipertensos atendidos no pronto socorro e 100 em acompanhamento ambulatorial no Hospital Universitário da Universidade de São Paulo (62% mulheres, 58 '+ OU -' 11 anos, 71% brancos, 64% com primeiro grau incompleto, 53% com ocupação manual não especializada, 53% com renda inferior a 5 salários mínimos e 53% não pertencentes à comunidade do hospital). Os hipertensos do pronto socorro foram significativamente diferentes (p<0,05) dos pacientes de ambulatório em relação a: pressão arterial mais elevada (174+27/109'+ OU -' 18 vs 143+20/88'+ OU -' 12 mm Hg); menor renda salarial; não pertencentes à comunidade do hospital (84% vs 23%); maior consumo de bebida alcoólica (92 vs 17 g de etanol/dia); descobriram ser hipertensos por sentir-se mal (60% vs 45%); mediam menos a pressão arterial (78% vs 96%); deixaram mais de tomar os remédios (44% vs 23%); e as mulheres usavam menos hormônio anticoncepcional (3% vs 16%). Os pacientes do ambulatório citaram mais dislipidemia (41%) como outros problemas de saúde, enquanto que para os do pronto socorro foram diabetes (42%), problemas cardíacos (19%) e hipertireoidismo (11%). O conhecimento sobre a doença e o tratamento não foi diferente entre os hipertensos do pronto socorro e ambulatório. Concluindo, as características desfavoráveis podem contribuir para que hipertensos não realizem tratamento anti-hipertensivo adequadamente, levando a atendimentos em unidades de emergência

Hypertensive patients dont't usually follow treatment appropriately, leading to diasease lack of control and assistance in first-aid units. The objective of this study describing hypertensives´profiles seen in first-aid units and comparing them with those who are seen in out-patient clinics regarding bio-social characteristics, life style, knowledge on the disease, and blood pressure treatment and levels. One-hundred hypertensives seen in the first-aid unit and 100 seen in the out-patient clinic of the School Hospital of the University of São Paulo were interviewed (62% women, 58'+ OR -'11 years, 71% white, 64% haven´t finished elementary school, 53% had non-specialized manual job, 53% had an income lower than US$419,45 monthly, and 53% did not belong to the hospital community). Hypertensives seen at the first-aid unit showed to be significantly different (p<0.05) from those seen at the out-patient clinic regarding: higher blood pressure (174'+ OR -'27/109'+ OR -'18 vs.143+20/88'+ OR -'12mmHg); lower income; not beloging to the hospital community (84% vs. 23%); greater alcohol intake (92 vs. 17g ethanol/day); got to know they were hypertensive because felt bad (60% vs. 45%); measured blood pressure less often (78% vs. 96%); did not take the medicine more often (44% vs. 23%); and the women use less anti-contraceptive hormone (3% vs. 16%). Patients seen at the out-patient clinic mentioned dyslipidemia more often (41%) as other health problems, whereas those seen at the out-patient clinic mentioned diabetes (42%), cardiac problems (19%), and hyperthyroidism (11%). The knowledge on the disease and treatment was not different between hypertensives seen at the first-aid unit and those seen at the out-patient clinic. In conclusion unfavorable characteristics can contribute to hypertensives do not follow anti-hypertension treatment adequately, leading to assistance in first-aid units