Antihypertensive drug utilization pattern and awareness in diabetic hypertensive patients at tertiary care centre
Keywords:
Diabetes, Hypertension, Antihypertensive drugs, Angiotensin receptor blockerAbstract
Background: Patients with diabetes has 2 fold higher chances of suffering from hypertension. Hypertension is risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Hypertension control is vital to prevent and retard progression of microvascular and macrovascular complications. Therefore, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute.
Methods: Study group comprised of diabetic patients who had hypertension as well. All patients with diabetes reporting to medicine OPD from March 2014 to September 2014 at our institute were screened. Patients with follow up of at least 3 months and age more than 18 years of either sex were included.
Results: There were 223 patients. Study group comprised of 121 males and 102 females. Mean age of group was 48.6 years. One hundred three patients (46.18%) were on monotherapy and remaining 120 patients were on combination antihypertensive drugs. There were total 398 antihypertensive drug exposures. Patient needed mean antihypertensive drug of 1.78. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in 158 (71%) patients. Hypertension control was achieved in 84 (37.66%) patients. One hundred eighty one patients (81.2%) knew about disease.
Conclusion: Our study showed that majority of diabetic hypertensive patients needed multiple drug therapy to control hypertension. Most of the patients were on ARBs/ACE inhibitors. This was according to recommendation by ADA or JNC8.
Metrics
References
Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, eds. Diabetes Atlas. International Diabetes Federation. 3rd ed. Brussels, Belgium: International Diabetes Federation; 2006: 15-103.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217-23.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
National Institutes of Health. Diabetes in America. In: NIH, eds. National Institutes of Diabetes and Digestive and Kidney Diseases. 2nd ed. Bethesda, MD: NIH Publication; 1995: 95-1468.
Miller GJ, Maude GH, Beckles GLA. Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad. J Epidemiol Community Health. 1996;50(5):497-504.
UKPDS 38. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UK prospective diabetes study group. BMJ. 1998; 317(7160):703-13.
James PA, Oparil S, Carter BL, Cushman WC, Dennison HC, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014;311(17):1809.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul;34(28):2159-219.
American Diabetes Association. Standards of medical care-2014. Diabetes Care. 2014 Jan;37(Suppl 1):S14-80.
Harrison. Chronic kidney disease. In: Fauci’s, Longo’s eds. Harrison's Principles Internal Medicine. 18th ed. United States: The McGraw-Hill Companies; 2008: 2308-2321.
Ref Yuen YH, Chang S, Chong CK, Lee SC, Critchlev JA, Chan JC. Drug utilization in a hospital general medical outpatient clinic with particular reference to antihypertensive and antidiabetic drugs. J Clin Pharm Ther. 1998;23:287-94.
Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis. 2000;36(3):646-61.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-97
Berlowitz DR, Ash AS, Hickey EC, Glickman M, Friedman R, Kader B. Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care. 2003;26(2):355-9.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462-536.
Nather A, Bee CS, Huak CY, Chew JL, Lin CB, Neo S, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complicat. 2008;22(2):77-82.
Reiber GE. The epidemiology of diabetic foot problems. Diabet Med. 1996;13(Suppl 1):S6-11.
Shah J, Khakhkhar T, Bhirud S, Shah RB, Date S. Study of utilization pattern of antihypertensive drugs in hypertensive diabetic patients with or without reduced renal function at tertiary care teaching hospital. Int J Med Sci Public Health. 2013;2:175-80.
Dhanaraj E, Raval A, Yadav R, Bhansali A, Tiwari P. Prescription pattern of antihypertensive agents in T2DM patients visiting tertiary care centre in North India. Int J Hypertens. 2012;2012:520915.
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. New Engl J Med. 2000;342(3):145-53
Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Tameem EJ. Patterns of antihypertensive therapy in diabetic patients with and without reduced renal function. Saudi J Kidney Dis Transpl. 2010;21:652-9.
Johnson M, Singh H. Patterns of antihypertensive therapies among patients with diabetes. J G Intern Med. 2005;20(9):842-6.
Ashfaq T, Anjum Q, Siddiqui H, Shaikh S, Vohra EA. Awareness about hypertension among patients attending primary health care centre and outpatient department of tertiary care hospital of Karachi. J Pak Med Assoc. 2007;57(8):396-9.
