8400-Article Text-50016-1-10-20090108
8400-Article Text-50016-1-10-20090108
8400-Article Text-50016-1-10-20090108
Abstract
Objective: This study examined the pattern of physicians’ prescription of antihypertensive drugs and its
possible effects on blood pressure control as well as physicians’ compliance with recommended
guidelines.
Methods: Records of 145 patients aged 17-91 (mean: 52.6 ± 14.6) years, with male to female ratio of
1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood
pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and
90mmHg, respectively.
Results: Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination
therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and
4 drugs, respectively. Diuretic was the most frequently prescribed drug either as a single agent (44.8%)
or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were
more in patients on calcium channel blocker than those on diuretic monotherapy (t = 2.5 and 3.6 for
reductions in systolic and diastolic BP, respectively; P < .05 for both), and, in patients on combination
therapy than those on monotherapy (t = 3.64 and 3.27 for reductions in systolic and diastolic BP,
respectively; P < .01 for both). Blood pressure control rate was 30.5%.
Conclusion: Our results are consistent with the previously observed benefits of antihypertensive
combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker
monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major
limitations of this work include its retrospective nature and the inability to determine the actual
patients’ adherence to therapy.
Résumé
Objectif: Cette étude a examiné le schéma de l’ordonance médicale (prescription médicamenteuse) des
antihypertenseurs et son effet possible dans le contrôle de l’hypertension artérielle ainsi que sa
comformité aux indications recommendées.
Methode: Les données de 145 patients âgés de 17 à 91 ans, (moyenne: 52, 6+ 14, 6) avec un rapport
d’un homme pour 1, 2 femmes, ont été recueillis au hazard. Des informations sur les ordonnances des
antihypertenseurs ont été enregistrées. Moins de 140mm/hg pour systolique et 90mm/hg pour
diastolique ont été retenus comme le contrôle.
Resultats: De 145 partients études, 20% soit patients étaient sur le régime monothérapie (combinée).
Pour les patient en régime multithérapie, 61, 2% soit 71, 33, 6% soit 39 et 5, 2% soit 6 étaient sur 2, 3,
et 4 médicaments respectivement. Les diurétiques étaient plus fréquemment prescript, soit seuls (44,
Page | 129 Prescription pattern of antihypertensive drugs in a tertiary institution in Nigeria. Etuk E. et al.
8%) ou en combinaison avec d’autres agents antihypertenseurs. La réduction moyenne dans les deux
cas de systolique et diastolique était plus élevée chez les patients prenant les diurétiques tout court. (=
2.5 et, 3.6 pour la réduction en systolique et diastolique respectirement; p<0.05 pour les deux cas), et
chez les patients en thérapie combinée que chez ceux en monothérapie (t = 3,64 et 3, 27 pour la
réduction en systolique et diastolique respectivement; p< 0.01) pour les deux cas_. Le taux de contrôle
était 30, 5%.
Conclusion: Nos résultats correspondent aux bénéfices déjà observés dans le régime de la thérapie
antihypertensive combinée, et montre une efficacité clairement élevée de beta-bloquants de calcium
(la chaine de bloquants de calcium) utilisés en monothérapie que les diurétiques utilisés en
monothérapie dans l’abaissement de la tension artérielle au sein de l’échantillon de l’étude.
prescribed antihypertensive is diuretic either singly patients with cardiac failure, renal disease, stroke,
(44.8%) or in combination with other anti- and diabetes mellitus, respectively. Angiotensin
hypertensive drugs (88.8%). Two drug combinations converting enzyme inhibitors (ACEIs), either singly or
appear to be the most frequent. It was prescribed in as part of combination therapy were the second most
26.8%, 38.0% and 29.6% of patients with mild, frequently prescribed drugs in hypertensive patients
moderate and severe hypertension respectively. with co-morbid conditions. It was prescribed in
Monotherapy and 3 or 4 drug combinations were 69.2%, 54.5%, 53.8%, and 14.3% of hypertensive
mainly prescribed for patients with mild (58.6%) and patients with heart failure, renal disease, diabetes
severe (68.9%) hypertension, respectively. mellitus, and stroke, respectively.
The baseline blood pressure tend to be higher as
the number of drugs prescribed increases with the
mean baseline blood pressures for patients on Table 1. Pattern of prescription of
monotherapy and combination therapy being antihypertensive drug
154.8 ± 8.3/95.5 ± 9.1 and 175.6 ± 32.8/109.5 ± 18.7
mm Hg, respectively (P < .05 for both systolic and Drug regime No (%)
diastolic blood pressures) (Table 2). Patients on (i) Monotherapy
combination therapy achieved significantly higher D 13 (44.8)
reduction in systolic and diastolic blood pressures C 8 (27.6)
compared to those on monotherapy A 5 (17.2)
(15.4 ± 17.0/7.0 ± 8.2 vs. 32.6 ± 26.6/18.7 ± 14.9 mm Alpha methyldopa 3 (10.4)
Hg; P < .05 for reductions in both systolic and (ii) 2 drug Combinations
diastolic blood pressures) (Table 2). However, further A+D 28 (24.1)
use of 3 or 4 drugs was not associated with Alpha methyldopa + D 16 (13.8)
significant benefit over 2 drug combinations in terms C+D 14 (12.1)
of reduction in blood pressures (P > .05 for both A+C 6 (5.2)
systolic and diastolic blood pressure reductions). Alpha methyldopa + C 5 (4.3)
There was no significant difference in baseline Valsartan + C 1 (0.9)
blood pressures of patients on calcium channel Hydrallazine + A 1 (0.9)
blocker monotherapy and those on diuretic (iii) 3 drug combinations
monotherapy (Table 3). However, calcium channel Alpha methyldopa + A + D 20 (17.2)
blocker monotherapy significantly lowers blood A+C+D 6 (5.2)
pressures more than diuretic monotherapy Alpha methyldopa + C + D 5 (4.3)
(28.6 ± 16.8/12.9 ± 5.7 vs. 11.7 ± 7.1/4.4 ± 3.0 mm Hg; A+B+D 4 (3.4)
P < .05). Satisfactory blood pressure control was B+C+D 3 (2.6)
achieved in 40 (30.5%) patients. (iv) 4 drug combinations
The co-morbid conditions that were documented Alpha methyldopa+ A + C + D 4 (3.4)
among the study population included diabetes Alpha methyldopa + B + C + D 1 (0.9)
mellitus (26.9%), cardiac failure (17.9%), renal Hydrallazine + Alpha methyldopa 1 (0.9)
disease (15.2%) and stroke (10.0%). Diuretic, either +
alone or in combination with other A+ D
antihypertensives, was the most frequently used A: Angiotensin converting enzyme inhibitor; B: Beta
drug in these groups of patients, the frequency of use blocker; C: Calcium channel blocker; D: Diuretic
being 100%, 91.7%, 85.7% and 61.5% of hypertensive
Table 3. Comparison of patients on calcium channel blocker monotherapy and diuretic monotherapy
control in a population where antihypertensives 14. real world evaluation of the efficacy, safety,
are given free. East Afr Med J. 2003; 80:529-531. rationality and pharmacoeconomics of old and
4. Isezuo AS, Njoku CH. Blood pressure control new antihypertensive drugs. J Hum Hypertens.
among hypertensives managed in a specialized 2003; 17:277-285.
health care setting in Nigeria. Afr J Med Med Sci. 15. Yusuff KB, Balogun OB. Pattern of drug utilization
2003; 32:65-70. among hypertensives in a Nigerian teaching
5. Isezuo SA, Opara TC. Hypertension awareness hospital. Pharmacoepidemiol Drug Saf. 2005b;
among Nigerian hypertensives in a Nigerian 14:69-74.
tertiary health institution. Sahel Medical Journal. 16. Guidelines Committee of the Nigerian
2000; 3:93-97. Hypertension Society. Guidelines for the
6. Hyman DJ, Pavlik VN. Characteristics of patients management of hypertension in Nigeria.
with uncontrolled hypertension in the United Nigerian Hypertension Society. 2005.
States. N Engl J Med. 2001; 345:479-486. 17. The ALLHAT Officers and Coordinators for the
7. Ren XS, Kazis LE, Lee A, Zhang H, Miller DR. ALLHAT Collaborative Research Group. Major
Identifying patient and physician characteristics outcomes in high-risk hypertensive patients
that affect compliance with antihypertensive randomized to angiotensin-converting enzyme
medications. J Clin Pharm Ther. 2002; 27:47-56. inhibitor or calcium channel blocker vs. diuretic:
8. The seventh report of the joint national The Antihypertensive and Lipid-Lowering
committee on prevention. Detection, evaluation, treatment to prevent heart attack trial (ALLHAT).
and treatment of high blood pressure (the JNC 7 JAMA. 2002; 288:2981-2997.
report). JAMA. 2003; 289:2560-2571. 18. Centre for Reviews and Dissemination, University
9. Guidelines Subcomittee. World Health of York. Effectiveness of antihypertensive drugs
Organization (WHO)/International Society of in black people. Eff Health Care. 2004; 8:1-12.
Hypertension (ISH) guidelines for the 19. Douglas JG, Bakris GL, Epstein M, et al.
management of hypertension. J Hypertens. Management of high blood pressure in African
1999; 17:151-185. Americans: consensus statement of the
10. Yusuff KB, Balogun OB. Physicians’ prescribing of Hypertension in African Americans. Working
antihypertensive combinations in a tertiary care Group of the International Society on
setting in southwestern Nigeria. J Pharm Pharm Hypertension in Blacks. Arch Intern Med. 2003;
Sci. 2005a; 8:235-242. 163:525-541.
11. Neutel JM. The role of combination therapy in 20. Guidelines Committee ESH-ESC. 2003 European
the management of hypertension. Oxford Society on Hypertension-European Society of
Journals. Nephrol Dial Transplant. 2006; Cardiology guidelines for the management of
21:1469-1473. arterial hypertension. J Hypertens. 2003;
12. Gavras I, Rosenthal T. Combination therapy as 21:1011-1053.
first-line treatment for hypertension. Curr 21. Yiannakopoulou ECh, Papadopulos JS, Cokkinos
Hypertens Rep. 2004; 6:267-272. DV, Mountokalakis TD. Adherence to
13. Adigun AQ, Ishola DA, Akintomide AO, Ajayi AAL. antihypertensive treatment: a critical factor for
Shifting trends in pharmacologic treatment of blood pressure control. Eur J Cardiovasc Prev
hypertension in a Nigerian tertiary hospital: a Rehabil. 2005; 12:243-249.