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Ram CVS, Muruganathan A, S M, Kumar M K. Indian Clinician's Perspective on the Approach to the Management of Hypertension: A Cross-Sectional Study. Cureus 2024; 16:e57435. [PMID: 38699103 PMCID: PMC11063652 DOI: 10.7759/cureus.57435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Hypertension (HTN) is considered one of the most frequent life-threatening noncommunicable illnesses. Because HTN has a significant public health impact on cardiovascular health status and healthcare systems in India, it is critical to study Indian clinicians' approaches to HTN management. Methodology This was a cross-sectional, multicentric, non-interventional, and single-visit study that aimed to gather data from across India and examine sociodemographic characteristics and clinician treatment choices in the management of HTN in Indian individuals. As a result, building an information platform about HTN is critical to preventing and controlling this growing burden. Results A total of 5298 patients were recruited in the study from 1061 study centers across India. Among the study patients, 66.67% were females with a mean age of 53.95 ± 14.4, and 66.28% of hypertensive patients presented comorbidities. Among the known risk factors for HTN, 2227 (44.5%) were smokers, while 2587 (51.7%) had sedentary lifestyles. A family history of HTN in either one or both parents was seen in 1076 (21.50%) patients. In management, 40.40% of patients were on anti-hypertensive monotherapy. Amlodipine (41.8%) in monotherapy and amlodipine + metoprolol (32.34%) in combination therapy were the most commonly prescribed antihypertensive. Conclusion Management of HTN can be improved by imparting patient education and awareness about the need for medication compliance, lifestyle modifications, and regular follow-up clinic visits.
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Affiliation(s)
- C Venkat S Ram
- Hypertension and Blood-Pressure Management Clinic, Apollo Hospitals, Hyderabad, IND
| | - A Muruganathan
- Department of Public Health, Shristy AG Hospital, Tirupur, IND
| | - Manjula S
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
| | - Krishna Kumar M
- Department of Medical Services, Micro Labs Ltd, Bengaluru, IND
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Bird GS, Lin YP, Tucker CJ, Mueller G, Shi M, Padmanabhan S, Parekh AB. Scrutinizing science to save lives: uncovering flaws in the data linking L-type calcium channels blockers to CRAC channels and heart failure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.06.579229. [PMID: 38370647 PMCID: PMC10871304 DOI: 10.1101/2024.02.06.579229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Hypertension is estimated to affect almost 1 billion people globally and significantly increases risk of myocardial infarction, heart failure, stroke, retinopathy and kidney disease. One major front line therapy that has been used for over 50 years involves L-type Ca 2+ channel blockers (LCCBs). One class of LCCBs is the dihydropyridine family, with amlodipine being widely prescribed regardless of gender, race, ethnicity or age. In 2020, Johnson et al. 7 reported that all LCCBs significantly increased the risk of heart failure, and attributed this effect to non-canonical activation of store-operated Ca 2+ entry. A major approach on which they based many of their arguments was to measure cytosolic Ca 2+ using the fluorescent Ca 2+ indicator dye fura-2. We recently demonstrated that amlodipine is highly fluorescent within cells and overwhelms the fura-2 signal, precluding the use of the indicator dye with amlodipine 24 . Our meta-analyses and prospective real world study showed that dihydropyridines were not associated with an increase in heart failure, likely explained by the lack of consideration by Johnson et al. 7 of well-known confounding factors such as age, race, obesity, prior anti-hypertensive treatment or diabetes 24 . Trebak and colleagues have responded to our paper with a forthright and unwavering defence of their work 27 . In this paper, we carry out a forensic dissection of Johnson et al., 7 and conduct new experiments that address directly points raised by Trebak et al. 27 . We show that there are major flaws in the design and interpretation of their key experiments, that fura-2 cannot be used with amlodipine, that there are fundamental mathematical misunderstandings and mistakes throughout their study leading to critical calculations on heart failure that are demonstrably wrong, and several of their own results are inconsistent with their interpretation. We therefore believe the study by Johnson et al. 7 is flawed at many levels and we stand by our conclusions.
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Bird GS, D’Agostin D, Alsanosi S, Lip S, Padmanabhan S, Parekh AB. A Reappraisal of the Effects of L-type Ca 2+ Channel Blockers on Store-Operated Ca 2+ Entry and Heart Failure. FUNCTION 2023; 4:zqad047. [PMID: 37841523 PMCID: PMC10568199 DOI: 10.1093/function/zqad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 10/17/2023] Open
Abstract
Dihydropyridines such as amlodipine are widely used as antihypertensive agents, being prescribed to ∼70 million Americans and >0.4 billion adults worldwide. Dihydropyridines block voltage-gated Ca2+ channels in resistance vessels, leading to vasodilation and a reduction in blood pressure. Various meta-analyses show that dihydropyridines are relatively safe and effective in reducing hypertension. The use of dihydropyridines has recently been called into question as these drugs appear to activate store-operated Ca2+ entry in fura-2-loaded nonexcitable cells, trigger vascular remodeling, and increase heart failure, leading to the questioning of their clinical use. Given that hypertension is the dominant "silent killer" across the globe affecting ∼1.13 billion people, removal of Ca2+ channel blockers as antihypertensive agents has major health implications. Here, we show that amlodipine has marked intrinsic fluorescence, which further increases considerably inside cells over an identical excitation spectrum as fura-2, confounding the ability to measure cytosolic Ca2+. Using longer wavelength Ca2+ indicators, we find that concentrations of Ca2+ channel blockers that match therapeutic levels in serum of patients do not activate store-operated Ca2+ entry. Antihypertensive Ca2+ channel blockers at pharmacological concentrations either have no effect on store-operated channels, activate them indirectly through store depletion or inhibit the channels. Importantly, a meta-analysis of published clinical trials and a prospective real-world analysis of patients prescribed single antihypertensive agents for 6 mo and followed up 1 yr later both show that dihydropyridines are not associated with increased heart failure or other cardiovascular disorders. Removal of dihydropyridines for treatment of hypertension cannot therefore be recommended.
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Affiliation(s)
- Gary S Bird
- Laboratory of Signal Transduction, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC 27709, USA
| | - Diane D’Agostin
- Laboratory of Signal Transduction, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC 27709, USA
| | - Safaa Alsanosi
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia
| | - Stefanie Lip
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
| | - Sandosh Padmanabhan
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
| | - Anant B Parekh
- Laboratory of Signal Transduction, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC 27709, USA
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Tolley A, Hassan R, Sanghera R, Grewal K, Kong R, Sodhi B, Basu S. Interventions to promote medication adherence for chronic diseases in India: a systematic review. Front Public Health 2023; 11:1194919. [PMID: 37397765 PMCID: PMC10311913 DOI: 10.3389/fpubh.2023.1194919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cost-effective interventions that improve medication adherence are urgently needed to address the epidemic of non-communicable diseases (NCDs) in India. However, in low- and middle-income countries like India, there is a lack of analysis evaluating the effectiveness of adherence improving strategies. We conducted the first systematic review evaluating interventions aimed at improving medication adherence for chronic diseases in India. Methods A systematic search on MEDLINE, Web of Science, Scopus, and Google Scholar was conducted. Based on a PRISMA-compliant, pre-defined methodology, randomized control trials were included which: involved subjects with NCDs; were located in India; used any intervention with the aim of improving medication adherence; and measured adherence as a primary or secondary outcome. Results The search strategy yielded 1,552 unique articles of which 22 met inclusion criteria. Interventions assessed by these studies included education-based interventions (n = 12), combinations of education-based interventions with regular follow up (n = 4), and technology-based interventions (n = 2). Non-communicable diseases evaluated commonly were respiratory disease (n = 3), type 2 diabetes (n = 6), cardiovascular disease (n = 8) and depression (n = 2). Conclusions Although the vast majority of primary studies supporting the conclusions were of mixed methodological quality, patient education by CHWs and pharmacists represent promising interventions to improve medication adherence, with further benefits from regular follow-up. There is need for systematic evaluation of these interventions with high quality RCTs and their implementation as part of wider health policy. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345636, identifier: CRD42022345636.
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Affiliation(s)
| | | | | | | | - Ruige Kong
- University of Cambridge, Cambridge, United Kingdom
| | - Baani Sodhi
- Indian Institute of Public Health-Delhi, Gurugram, India
| | - Saurav Basu
- Indian Institute of Public Health-Delhi, Gurugram, India
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Linu Mohan P, Khadeejathul Nadishaa T, Dilip C. Appraising the compliance to Joint National Committee-8 Guidelines for antihypertensives in a teaching hospital by drug utilization evaluation method and impact of patient counselling. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
To evaluate the prescribing pattern of antihypertensive drugs and its compliance to the recommendations of Joint National Committee 8 (JNC 8) guidelines and assess the impact of pharmacist led patient counselling on hypertension management.
Methods
A prospective study was carried out for a period of one year (September 2020–October 2021) among 150 hypertensive patients of various departments in a tertiary care hospital, Kerala, India. All the cases were prospectively analysed to study the pattern of antihypertensive use and patients were counselled with a patient information leaflet.
Key findings
Out of 150 patients, 53% were women and 47% were men. Majority of patients were aged 60 years and above (66.0%). Diabetes mellitus (26%) was the most common co-morbidity associated with hypertension. About half of the patients had received dual therapy (49%) followed by monotherapy (31.3%), triple therapy (18%) and quadruple therapy (2%). Calcium channel blockers (59.8%) were the most frequently prescribed drug class followed by angiotensin II receptor blockers (30.5%) either alone or in combination for effective control of blood pressure. Cilnidipine (8.7%) was the most commonly used antihypertensive drug followed by telmisartan (8%). It was observed that 80% of prescriptions were adherent to JNC 8 hypertension treatment recommendations. There was a significant difference (P < 0.001) in the knowledge-awareness scores before (18%) and after (52%) patient counselling.
Conclusion
The study represents the utilisation pattern of antihypertensive drugs. The adherence of antihypertensive medication use to JNC 8 guidelines was high level at the study site but needs to improve further. The study concludes that pharmacist-led counselling plays a vital role in improving patients’ knowledge and awareness towards hypertension management.
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Affiliation(s)
- Panakkal Linu Mohan
- Department of Pharmacy Practice, Al Shifa College of Pharmacy , Kerala , India
| | | | - Chandrasekhar Dilip
- Department of Pharmacy Practice, Al Shifa College of Pharmacy , Kerala , India
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Renganathan J, S IUH, Ramakrishnan K, Ravichandran MK, Philip L. Spatio-temporal distribution of pharmaceutically active compounds in the River Cauvery and its tributaries, South India. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 800:149340. [PMID: 34399341 DOI: 10.1016/j.scitotenv.2021.149340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
Pharmaceutically active compounds (PhACs) present in the environment are a great threat to human well-being and the ecosystem. Eventhough recognized as the pharmacy of the world", studies addressing the distribution of PhACs in the Indian environment are scarce. Hence, in the current study, selected PhACs, heavy metals (HMs), and physicochemical parameters (PCPs) were measured from the surface waters of the River Cauvery during the pre- and post-monsoon. PhACs such as caffeine, carbamazepine, and diclofenac were detected in most samples, whereas topiramate, ibuprofen, and verapamil were found only in few stations. In contrast, the distribution of ciprofloxacin, atenolol, and isoprenaline was strongly influenced by the seasonal pattern (p < 0.05). PhACs such as loperamide, glafenine, erythromycin, and gemfibrozil were not detected during the study. Distribution of PhACs based on average concentration (ng/L) are, CBZ (205.62) > CAF (114.09) > DCF (28.51) > CIP (25.23) > ATL (18.86) > IPL (13.91) > PPL (11.26) > TCS (10.39) > IBF (7.34) > TPT (3.09) > VPL (1.16). Bivariate and multivariate statistical analyses have revealed a positive correlation expressed by the majority of the PhACs with PCPs (COD, TOC), nutrients (TN, TP), and HMs (Pb, Mn, Ni) in the range from 0.540** to 0.961**(p < 0.01). Whereas, DO revealed negative correlation with most of the parameters in the range from -0.559** to -0.831** (p < 0.01). A high average concentration of PhACs was recorded in the upstream (52.08 ng/L) and wastewater discharge points (55.60 ng/L). Further, the environmental risk assessment study has identified the higher risk exhibited by TCS (RQ: 3.29) and CAF (RQ: 38.82) on algae and Daphnia respectively. The study portrays the distribution of emerging contaminants in the River Cauvery and its tributaries and also delivers preliminary data about the distribution of isoprenaline, topiramate, verapamil, and perindopril in the Indian freshwater system.
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Affiliation(s)
- Jayakumar Renganathan
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Chennai, Tamil Nadu 600 036, India
| | - Insamam Ul Huq S
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Chennai, Tamil Nadu 600 036, India
| | - Kamaraj Ramakrishnan
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Chennai, Tamil Nadu 600 036, India
| | - Manthiram Karthik Ravichandran
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Chennai, Tamil Nadu 600 036, India
| | - Ligy Philip
- Environmental and Water Resources Engineering Division, Department of Civil Engineering, Indian Institute of Technology, Chennai, Tamil Nadu 600 036, India.
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Simegn BK, Chelkeba L, Alamirew BD. Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study. PLoS One 2021; 16:e0259421. [PMID: 34780479 PMCID: PMC8592482 DOI: 10.1371/journal.pone.0259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Many studies conducted in the past focused on patients’ sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians’ adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians’ prescribing patterns, patients’ medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center. Methods A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients’ specific data was collected with a face-to-face interview and from their medical charts. Clinicians’ related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients’ adherence. P-Values of less than 0.05 were considered statically significant. Results From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients’ medication adherence was 46.6%, while clinicians’ guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence. Conclusion The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.
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Affiliation(s)
- Bekalu Kebede Simegn
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Dessie Alamirew
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Kebede B, Chelkeba L, Dessie B. Rate of blood pressure control and its determinants among adult hypertensive patients at Jimma University Medical Center, Ethiopia: Prospective cohort study. SAGE Open Med 2021; 9:20503121211006000. [PMID: 34659760 PMCID: PMC8514076 DOI: 10.1177/20503121211006000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Despite the fact that the goals for the management of hypertension are well-defined and effective therapies are available, control of hypertension remains poor in countries with low resources including Ethiopia. This study aimed to determine blood pressure control rate and its determinants among ambulatory adult hypertensive patients at Jimma University Medical Center. Methods A general prospective cohort study was conducted among adult hypertensive patients who had regular follow-up at Jimma University Cardiac Clinic from 20 March to 20 June 2018. Hypertensive patients who fulfilled the inclusion criteria were selected in the first month of the data collection period. Then, only those patients who visited the clinic at the first month were consequently followed-up for the next 3 months. The Eighth Joint National Committee guideline was used to categorize controlled and uncontrolled blood pressures. Patients' specific data were collected using a structured data collection tool. Data were analyzed using the statistical software package SPSS version 21.0. Bivariate and multivariable logistic regression analysis was used to identify independent variables influencing blood pressure control. p-values of less than 0.05 were considered statistically significant. Results From a total of 416 patients, 237 (57.0%) were male with a mean age of 56.50 ± 11.96 years. Two hundred and fifty eight (62.0%) participants had comorbid conditions and 275 (66.1%) were on combination therapy. The rate of blood pressure control was 42.8%. Age ⩾60 years was negatively associated with uncontrolled blood pressure (adjusted odd ratio = 0.52, confidence interval = 0.31-0.88, p = 0.015). Medication non-adherence (adjusted odd ratio = 1.64, confidence interval = 1.04-2.58, p = 0.034) and non-adherence to international guidelines (adjusted odd ratio = 2.33, confidence interval = 1.49-3.64, p < 0001) were positively associated with uncontrolled blood pressure. Conclusion The rate of blood pressure control among hypertensive patients was suboptimal. Age, clinicians' non-adherence to international guidelines, and patients' non-adherence to medications were independent predictors of blood pressure control. Physicians and clinical pharmacists should adhere to guidelines for better treatment and care of hypertensive patients.
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Affiliation(s)
- Bekalu Kebede
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Bekalu Dessie
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Akkawi ME, Mohd Taufek NH, Abdul Hadi AD, Nik Lah NNNF. The Prevalence of Prescribing Medications Associated with Geriatric Syndromes among Discharged Elderly Patients. J Pharm Bioallied Sci 2021; 12:S747-S751. [PMID: 33828372 PMCID: PMC8021066 DOI: 10.4103/jpbs.jpbs_305_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/06/2020] [Accepted: 03/29/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: A geriatric syndrome is a group of signs and symptoms that occur in older people and do not fit into a discrete disease. Several medications were reported to be associated with the incidence of geriatric syndromes. Objective: The objective of this study was to investigate the prevalence and pattern of medications associated with geriatric syndromes (MAGSs) among the discharged elderly patients (≥65 years old). Materials and Methods: This is a cross-sectional study that was conducted at a Malaysian teaching hospital from October to December 2018. The discharge medications of geriatric patients were reviewed to identify MAGSs using Beers criteria, Lexicomp drug information handbook, and the United States Food and Drug Administration (USFDA) drug inserts. Chi-square test was used to compare MAGS prescribed between categories. Spearman’s rank-order correlation was used to test the correlation between the presence of MAGS and the number of discharge medications. A binomial logistic regression was applied to determine the predictors of prescribing MAGSs. Results: A total of 400 patients (mean ± standard deviation [SD] age, 72.0 ± 5.0 years) were included, and 45.3% of them were females. The most common diseases were hypertension followed by diabetes mellitus. The mean ± SD number of discharge medications per patient was 4.2 ± 2.5. The MAGSs were prescribed in 51.7% of the patients, and 54 patients were discharged with more than one MAGSs. The most commonly prescribed MAGSs were opioid analgesics, vasodilators, and β-blockers, which are associated with falls, depression, and delirium. Polypharmacy was found in 138 patients, and it was significantly associated with the presence of MAGSs (P < 0.001). No significant differences were found in prescribing MAGSs based on the patients’ gender, race, and age. Conclusion: The prescribing of MAGSs occurred in half of the discharged elderly patients. Physicians should be aware of the medications that are associated with special side effects in the elderly patients, and should switch to safer alternatives when possible.
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Affiliation(s)
- Muhammad Eid Akkawi
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Hidayah Mohd Taufek
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Azfar Diyana Abdul Hadi
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nik Nur Nadia Fatin Nik Lah
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Arshad V, Samad Z, Das J, Almas A, Rashid N, Virani SS, Bloomfield GS, Jafar TH, Ahmed B. Prescribing Patterns of Antihypertensive Medications in Low- and Middle-Income Countries: A Systematic Review. Asia Pac J Public Health 2020; 33:14-22. [PMID: 33084371 DOI: 10.1177/1010539520965280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension is highly prevalent, but its pharmacological management has not been well evaluated in low- and middle-income countries (LMICs). This review examined the prescribing patterns of antihypertensives in LMICs. Data were extracted from a total of 26 studies spanning the time period 2000 to 2018. In 10 studies, calcium channel blockers (CCBs) were the most frequently prescribed medication for managing hypertension (range = 33% to 72%); in six studies, renin angiotensin system (RAS) blockers (range = 25% to 83%); in five studies, diuretics (range = 39% to 99%); and in five studies, β-blockers (BBs; range = 26% to 49%) were the most commonly prescribed antihypertensive medications. Prescribing sedatives and sublingual administration of captopril for controlling hypertension was also reported in 3 studies. Only 10 studies presented their findings in light of national or international guidelines. This review calls for further antihypertensive utilization and dispensation studies and a better understanding of clinician's perception and practice of hypertension management guidelines in LMICs.
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Affiliation(s)
| | | | - Jai Das
- The Aga Khan University, Karachi, Pakistan
| | | | | | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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Alkaabi MS, Rabbani SA, Rao PGM, Ali SR. Prescription Pattern of Antihypertensive Drugs: An Experience from a Secondary Care Hospital in the United Arab Emirates. J Res Pharm Pract 2019; 8:92-100. [PMID: 31367644 PMCID: PMC6636421 DOI: 10.4103/jrpp.jrpp_18_85] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective The aim of the study was to examine the prescription pattern of antihypertensive drugs used in a secondary care hospital in the United Arab Emirates (UAE). Methods It was a prospective, observational study carried out in 588 adult hypertensive patients presenting to medicine outpatient and inpatient departments of Dibba Hospital, Fujairah, UAE. The study was conducted for a period of 6 months from December 2017 to May 2018. Demographic and clinical data were collected from electronic patient case records and documented. Prescriptions were studied overall for drug use details and for specific types of antihypertensive drugs. The World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose methodology was further used to calculate utilization. Statistical analysis of data was performed using Statistical Package for the Social Sciences 24.0. Findings Of the 588 study participants, majority of the patients were on two-drug combination antihypertensive therapy (n = 210, 35.5%) followed by monotherapy (n = 188, 32.1%) and three-drug combination (n = 136, 23.1%). Calcium channel blockers were the most frequently (51%) prescribed class both in monotherapy and in combination therapy while angiotensin receptor blockers and angiotensin-converting enzyme inhibitors (55.9%) were the most preferred agents for monotherapy. Among individual antihypertensive drugs, amlodipine was prescribed the most (266 prescriptions), irrespective of monotherapy or combination therapy. Conclusion Our study represents the current prescribing trends of antihypertensive drugs in a secondary care hospital in the UAE. The use of antihypertensive drugs largely conforms to international guidelines, but still, there is room for improvement in terms of rational drug utilization.
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Affiliation(s)
- Maryam Salem Alkaabi
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Padma G M Rao
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
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Varakantham V, Kurakula Sailoo AK, Bharatraj DK. Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study. Hosp Pharm 2018; 53:107-112. [PMID: 29581605 DOI: 10.1177/0018578717738080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results: A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics (P < .001). Most notably, there was a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs 11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar year 2012 than in the calendar year 2014 (P < .001). Conclusions: Antihypertensive medication use has gone through wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals.
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