Introduction-Hypertension in hypertension is complex and many factors

Introduction-Hypertension is a major health problem all over the world. It is defined as rise in both systolic and diastolic blood pressure. It is an important risk factor for cardiovascular mortality and morbidity. Hypertension rarely causes symptoms in early stages and many people go undiagnosed. One quarter of the world’s adult population has hypertension. In India 25% of urban and 10% rural subjects are hypertensive.According to JNC 8, in general population of adults (1)• ? 60 years, start pharmacotherapy at 150/90 mmHg.• ? 60 years, start pharmacotherapy at 140/90 mmHg.Obesity, dyslipidemia, insulin resistance and diabetes mellitus often coexist with hypertension. Poor control of hypertension can lead to ischemic heart disease, heart failure, stroke and chronic renal insufficiency. (2)The aim of antihypertensive therapy is to prevent morbidity and mortality associated with persistently raised blood pressure by lowering it to an acceptable level, without inconvenience to the patient. (3)Drug  prescription in hypertension is complex and many factors such as polypharmacy, comorbid conditions, pharmacokinetic, pharmacodynamic variability and non compliance make this group a high risk as far as drug is concerned.(4)  Large number of antihypertensive drugs are available; the choice is based on efficacy, side effects, effect on other system and cost. Accordingly, there is a need to survey the pattern of usage of antihypertensive drugs to see if the current usage is rational and in accordance with current guidelines for treatment of hypertension. Hence, this study is done to know the current prescribing pattern of antihypertensive agents in a tertiary care hospital.Table 1. Classification of  Blood Pressure as per JNC-8 guidelines: (5)Category Systolic DiastolicNormal <120 <80Pre-hypertension 120-139 80-89Stage 1 hypertension 140-159 90-99Stage 2 hypertension ?160 ?100The overall principle is to implement lifestyle modifications in addition to pharmacotherapy to control BP in patients with hypertension. Patient's optimal adherence with antihypertensive drug therapy is essential for preventing serious complications with hypertension over the long term.(6)Objectives –• To know about the prescribing pattern and physians adherence to the guidelines.• Antihypertensive medication utilization and adherence to treatments by patients• Drugs mostly preferred in different age groups from 18 to 60 years. • Initially which drug is given to different patients.• To analyze different classes of drugs.• Frequently used combinations?Methodology –A prospective and cross sectional study based on prescription pattern of hypertensive patients will be carried out to analyze the prescriptions written for patients with essential hypertension who attended the medicine OPD of a tertiary care hospital. Prescription  of  patients above 18 years are collected. Antihypertensive drugs were categorized according to the eight  report of JNC on prevention, detection, evaluation and treatment of  high blood pressure. Table 1. Usual inclusion and exclusion criteria  Inclusion Criteria Exclusion Criteria1. Age/sex: men and women aged ? 60 years. 1. Age/sex: men and women aged ? 60 years.2. Patients with history of hypertension or diagnosed with hypertension. 2.  Patients with cardiovascular            Disorders, stroke, asthma, diabetes. Antihypertensive drugs were classified into six major groups – ACE inhibitors, Angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers and alpha blockers. Accoding to WHO, medicines to be used are amlodipine, bisoprolol, enalapril, hydralazine, hydrochlorthiazide, methyl dopa and sodium nitroprusside. (7)  Data regarding monotherapy, two drugs regimen, three drug regimen, four drug regimen are to be recorded.Implications-? Frequently used drugs and their combinations.? Adherence of  patient to which class of the drug.? Adherence of the physician to the JNC-8 guidelines and WHO essential drug list.? Rational use of antihypertensive drugs.


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