Published: 2016-12-16

An assessment of antihypertensive drug prescription patterns and adherence to joint national committee-8 hypertension treatment guidelines among hypertensive patients attending a tertiary care teaching hospital

Rakesh Romday, Ajay Kumar Gupta, Pawan Bhambani


Background: The new guidelines issued by the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-8) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Patient non-adherence is a serious obstacle to the effective treatment of many acute and chronic disorders. Successful treatment and outcome of a chronic disease such as hypertension depend on many factors, including resources (e.g., funds, space, and people), avoidance of serious adverse events, patient adherence with treatment plans, and the availability of effective therapies. The aim of this study is to assess the antihypertensive drug prescription patterns and adherence to joint national committee (JNC-8) hypertension (HT) treatment recommendations among hypertensive patients attending a tertiary care teaching hospital.

Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year in ambulatory patients attending medicine OPD. A total of 500 prescriptions prescribed to diagnose HT were analyzed. Drug prescription patterns, and their adherence to JNC-8 report was assessed.

Results: Out of 500 patients, 299 (59.8%) were male and 201 (40.2%) were female. Mean age of male and female patients were found to be 57.68±15.32 and 61.29±12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6%) to control BP followed by two-drug combination (18.4%), three-drug combination (11.8%) and four-drug combination (3%). Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4%) was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6%) and Calcium channel blocker + ACEIs combination (2.6%). No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension); 87.90% (Stage 1 hypertension); and 68.20% (Stage 2 hypertension).

Conclusions: In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions.



Adherence, Anti-hypertensive drugs, Hypertension, Joint national committee-8 guidelines, Prescription patterns

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A global brief on hypertension: Silent killer, global public health crisis. WHO/DCO/WHD/2013.2. Accessed 11th August 2016.

Franklin SS, Gustin W, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age related changes in blood pressure. The Framingham heart study. Circulation. 1997;96:308-15.

Chobanian AV1, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.

Causes of Death 2008 [online database]. Geneva, World Health Organization. http :// 14th July 2016.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380 (9859):2224-60.

World Health Organization. Global status report on non-communicable diseases 2010. Geneva, World Health Organization, 2011.

World Health Organization. Global Health Observatory Data Repository [online database]. Geneva, World Health Organization, 2008 ( gho/ data/ view.main) Accessed 11th February 2013.

Munger MA. Polypharmacy and combination therapy in the management of hypertension in elderly patients with co-morbid diabetes mellitus. Drugs Aging. 2010;27(11):871-83.

Ginsberg G, Hattis D, Russ A, Sonawane B. Pharmacokinetic and pharmacodynamic factors that can affect sensitivity to neurotoxic sequelae in elderly individuals. Environ Health Perspect. 2005;113:1243-9.

Cooney D, Pascuzzi K. Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med. 2009;25:222-33.

Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. Task Force Members. 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). J Hypertens. 2013; 31:1281-357.

Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32:3-15.

McManus RJ, Caulfield M, Williams B; National Institute for Health and Clinical Excellence. NICE hypertension guideline 2011: evidence based evolution. BMJ. 2012;344:e181.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 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;311:507-20.

Stephan D, Gaertner S, Cordeanu EM. A critical appraisal of the guidelinesfrom France, the UK, Europe and the USA for the management of hypertension in adults. Arch Cardiovasc Dis. 2015;108:453-9.

Daskalopoulou SS, Rabi DM, Zarnke KB, et al. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2015;31:549-68.

Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years A Randomized Clinical Trial. JAMA. 2016;315(24):2673-82.

Surapaneni SS, Arifa SN, Venigalla SV, Peter PLH, Pingili R, Challa SR. An Assessment of Antihypertensive Drug Utilization Patterns and Adherence to JNC-7 Guidelines in South Indian Tertiary Care Teaching Hospital. Indian J Pharmacy Practice. 2015;8(4):177-82.

Pai PG, Shenoy J, Sanji N. Prescribing patterns of antihypertensive drugs in a South Indian tertiary care hospital. Drug Invention Today. 2011;3(4):38-40.

Tandon VR, Sharma S, Mahajan S, Mahajan A, Khajuria V, Mahajan V, et al. Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women. J Mid-Life Health. 2014;5(2):78-83.

Mohd AH, Mateti UV, Konuru V, Parmar MY, Kunduru BR. A study on prescribing patterns of antihypertensives in geriatric patients. Perspect Clin Res. 2012;3:139-42.

Data S, Sharma C. Prescribing patterns of antihypertensive in patients having comorbid ischemic heartdiseases. Study in Tertiary care Hospital. J Pharm Res. 2010;32:142-4.

Etuk E, Isezuo SA, Chika A, AkucheJ, Ali M. Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria. Ann Af Med. 2008;7(3):128-32.

Jeschke E, Ostermann T, Vollmar HC, Kröz M, Bockelbrink A, Witt CM, et al. Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: A prospective observational study. BMC Fam Pract. 2009;10:78.

Axon RN, Nietert PJ, Egan BM. Antihypertensive medication prescribing patterns in a university teaching hospital. J Clin Hypertens (Greenwich). 2010;12:246-52.

Liu PH, Wang JD. Antihypertensive medication prescription patterns and time trends for newly diagnosed uncomplicated hypertension patients in Taiwan. BMC Health Serv Res. 2008;8:133.

Sandozi T, Emani VK. Survey of prescription pattern of anti-hypertensive drugs in hypertensives & hypertension associated diabetics. Int J Pharma Bio Sciences. 2010;1(4):23-6.

Bernard MY, Wong YL, Lau CP. Queen Mary Utilization of Antihypertensive Drugs Study (QUADS): use of antihypertensive drug classes in the Hypertension Clinic 19962004. Br J Clin Pharmacol. 2005;60(1):90-7.

Tiwari H, Kumar A, Kulkarni SK. Prescription monitoring of antihypertensive drug utilization at the Punjab University Health Centre in India. Singapore Med J. 2004;45(3):117-20.

Brahmankar, Jaiswal SB. Biopharmaceutics and Pharmacokinetics- A Treatise. Vallabh Prakashan, 2nd Edition, Delhi. 2009;418:435-40.

Dipiro JT, Talbert RL, Yee GC, Wells BG, Posey LM. Pharmacotherapy A Pathophysiologic Approach. Seventh edition, 2008, McGraw-Hill Medical, New York, United States of America. 2008.

Jhaj R, Goel NK, Gautam CS, Hota D, Sangeeta B, et al. Prescribing patterns and cost of antihypertensive drugs in an internal medicine clinic. Ind. Heart J. 2001;53:323-7.

Malhotra S, Karan R, Pandhi P, Jain S. Pattern of use and pharmacoeconomic impact of antihypertensive drugs in a North Indian referral hospital. Eur J Clin Pharmacol. 2001;57:535-40.

Kothari N, Ganguly B. Adherence to JNC-VII and WHO-ISH guidelines of antihypertensive medications prescribed to hypertensive patients with co-morbid conditions. Indian J Physiol Pharmacol. 2015;59(1):48-56.

Murti K, Khan MA, Dey A, Sethi MK, Das P, Pandey K. Prescription Pattern of Anti-Hypertensive Drugs in Adherence to JNC- 7 Guidelines. American Journal of Pharmacology and Toxicology. 2015;10(1):27-31.

Pittrow D, Kirch W, Bramlage P, Lehnert H, Höfler M, et al.. Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol. 2004;60:135-42.

Lee PK, Li RK, Chan JC, Chang S, Lee SC, Tomlinson B, Critchley JA. A prescription survey in a hospital hypertension outpatient clinic. Br J Clin Pharmacol. 1997;44(6):577-82.

Amira CO, Okubadejo NU. Antihypertensive pharmacotherapy in a developing economy: pattern, acquisition costs and conformity to international guidelines in a tertiary-care setting. Journal of Human Hypertension. 2006;20:894-7.

Sakthi S, Thomas S, Sivakumar KK, Karhikeyan J, Saravana Kumar N. Assessment of anti-hypertensive prescribing pattern and patient counseling in an urban population. Der Pharmacia Lettre. 2010; 2(4):156-63.

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.

Blix HS, Landmark K, Selmer R, Reikvam A. Patterns in the prescription of antihypertensive drugs in Norway, 19752010. Tidsskr Nor Laegeforen. 2012;132:1224-8.

Astrand B, Astrand E, Antonov K, Petersson G. Detection of potential drug interactions - a model for a national pharmacy register. Eur J Clin Pharmacology. 2006;62(9):749-56.

Tragni E, Casula M, Pieri V, Favato G, Marcobelli A, Trotta MG, Captano AL. Prevalence of the Prescription of Potentially Interacting Drugs. PLOS ONE. 2013;8(10):e78827.