A prescription survey in a hospital hypertension outpatient clinic

Anti hypertensive prescribing patterns and cost analysis for primary hypertension: a retrospective study

OBJECTIVE

The present study was conducted to analyze the current prescription pattern and cost analysis of antihypertensive drugs in hypertensive patients in a tertiary care hospital.

MATERIALS AND METHODS

A retrospective cross-sectional study was conducted in tertiary care hospital, Bangalore for three months and utilized 300 prescriptions for the analysis. The data analysed from the prescription included patients demographics, stage of hypertension according to JNC VII guidelines, type of drug therapy, class of anti-hypertensive, and cost effectiveness of therapy. Drug acquisition costs was calculated, using the cost of the cheapest available drug and the most commonly prescribed dosage, for each drug on a daily and annual basis. Total annual drug expenditure on buying required doses of all antihypertensive prescribed in the study population for a year was calculated.

RESULTS

Monotherapy (48.94%) was leading trends of antihypertensive therapy followed by fixed dose combination (35.04%) and polytherapy (16.01%). The most frequent antihypertensive class to be prescribed were CCBs (38.59%) followed by beta blockers (24.07%). The ranking in terms of cost utilized per year from the highest to the lowest found in this study was: alpha blockers> ACE-inhibitors> ARBs> CCBs> beta blockers > diuretics. The diuretics were most cost-effective (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensive prescribed.

Utilization of lipid-lowering drugs in men and women. a reflection of the research evidence?

This study analyzes the utilization of statin lipid-lowering drugs in a Canadian province using a population-wide drug prescription database. The utilization pattern is compared to the results of a systematic review of randomized controlled trials on their effectiveness. The study found that 74.7% of individuals prescribed a statin had no reported history of coronary heart disease (CHD). Women without CHD formed 23.1% of statins recipients; 32.9% of individuals filling a statin prescription were age 70 and over. Only 15.3% of men with CHD had been prescribed a statin. Based on the systematic review, 88.7% of the utilization of statins in this Canadian province was not supported by the results of the systematic review. Considering baseline lipid-levels does not substantially alter these findings. This study concludes that statins prescribing practices need to be realigned with research evidence. This implies refocusing utilization away from women and the elderly, towards men with CHD.

The use of antihypertensive therapy in Spain (1986-1994)

We aimed to analyze the trends in antihypertensive therapy in Spain during the period 1986 to 1994, as well as the change in the pattern of different drugs, in relation to different national/international recommendations for hypertension treatment. Antihypertensive consumption was studied using the defined daily dose (DDD) and the DHD (DDD/1000 inhabitants/day) of each drug, as defined by the Drug Utilization Research Group of the European Office of the World Health Organization. The anatomical classification of hypotensive drugs has been made according to EPhMRA (European Pharmaceutical Market Association) guidelines. A significant increase of 117.4% (41.39/90 DHD) in antihypertensive drug consumption was observed in the period 1986 to 1994. In 1986 diuretics were the most consumed (30.27 DHD), followed by calcium antagonists (5.37), beta-blockers (3.93), and the angiotensin-converting enzyme (ACE) inhibitor (1.37). In 1994 ACE inhibitors, calcium antagonists, and beta-blockers increased significantly (P < .0001), whereas diuretics were still the most commonly prescribed. Nifedipine and captopril were the most used among calcium antagonists and ACE inhibitors. National and international recommendations had no effect on prescription patterns. Antihypertensive therapy of all types is increasing in Spain. Diuretics remain the most popular, beta-blockers stay stable, whereas the newer types are rising rapidly. National and international recommendations had no effect on prescription patterns.

Use of indapamide in hospital and community clinics and its effect on plasma potassium in Chinese patients

OBJECTIVES

To investigate the usage pattern of indapamide and other antihypertensive drugs in patients attending a community-based government outpatient clinic (GOPC) or a hospital-based specialist clinic (SC). The plasma potassium concentrations of patients receiving indapamide and other diuretics were also examined.

METHOD

Prescriptions from the SC and the GOPC were reviewed and collected during January 1998. Patients' plasma potassium concentrations and the date of initiation of each medication were retrieved from the hospital computer databases at SC. An age- and sex-matched control group of patients on non-diuretic antihypertensive drugs was identified.

RESULTS

A total of 1648 and 773 prescriptions were collected from the SC during a 1-week period and GOPC during a 1-month period, respectively. Approximately half (45%) of the patients received antihypertensive treatment. Indapamide was five times more frequently prescribed in GOPC than SC (84.7 vs. 17.7%, P<0.001). Calcium channel blocking agents were the commonest antihypertensive drugs used in both clinics. The mean plasma potassium concentration of patients taking indapamide was lower than that of the control group (P = 0.037). Multiple linear regression analysis showed that consumption of indapamide (P =0.002) and duration of diuretic therapy (P = 0.023) were significantly related to changes in plasma potassium concentrations [multiple regression equation for potassium level = 4.09-0.145 (thiazide = 1)-0.377 (indapamide = 1) -0.00468 (duration of diuretic therapy in months)].

CONCLUSION

Indapamide was used extensively in the community clinic and less in the hospital-based outpatient clinic. Patients receiving indapamide had a significantly lower plasma potassium concentration as compared to other diuretics or antihypertensive groups and this was predicted by a multiple linear regression model. Monitoring plasma electrolytes before initiation of indapamide treatment and at regular intervals thereafter is essential for detecting the hypokalaemia that may occur in Chinese patients.