Prescribing pattern and adverse drug reactions of anti hypertensive drugs in Kishanganj hospital

Simar Deep Singh^1*, Jagmehak Kaur Satyal²

Abstract              Irrational drug prescribing is a common practice globally; it results in increased morbidity, mortality and economic burden on society. Drug utilisation studies are an important tool to promote rational prescribing. Methods: The subjects’ screening and recruitment was carried out at the Department of General Medicine, M.G.M Medical College and L.S.K Hospital, Kishanganj, Bihar. The entire study starting from patient recruitment, data collection, data analysis to reporting took about one year starting from 1st March 2015 to 31st February2016. The patients those are diagnosed as a newly hypertensive are entered in this study except those are matched with exclusion criteria. The treatment was started as per advice of the treating Physician. On next visit the other parameters like Lipid Profile, Blood Urea, Serum Creatinine, Thyroid function test, Blood Sugar, Uric Acid, ECG, Echo Cardiography, CBC, are also reviewed along with monitor of blood pressure. Total 500 randomly selected patients, aged from 18 to 69 yrs, those were attend in the outpatients Department of Medicine, during the study period, who are newly diagnosed as hypertensive or previously diagnosed hypertensive but not started the medication were included initially in my study. Result: Age and Sex wise distribution of the study population. Total 219 Patients were diagnosed with essential hypertension who were selected for my study. For each patient the age, gender, age at which hypertension was diagnosed; In our study 121(55.25%) patients were males and 98(44.75%) patients were females ratio was 1:0.80. distribution of mono therapy treatment of the study population. It observed, Patients those were under treatment of CCB -79 (55.24%), Diuretics - 41(28.68%), ACEI - 8 (5.59%), ARB – 8 (5.59%), and β- Blocker -7 (4.89%), out of 143 Patients. Conclusion: This prospective, observational study on assessment of prescribing pattern for hypertension confirmed that mono therapy was prescribed than the combination therapy. Specify with the guidelines, the most frequently prescribed drug class followed by CCB, diuretics, ARBs and ACEI, beta blockers. When considering combination therapy, two drug combination was prescribed. In two drug combination, CCB+Diuretics was mostly prescribed. Regarding the perception of physicians towards JNC 8 guidelines it was found that majority were following JNC 8 guidelines

Key Word: Prescribing pattern, adverse drug reactions.

INTRODUCTION

Hypertension is a major contributor to cardiovascular morbidity and mortality in India and worldwide¹. The magnitude of the problem in industrialised and westernised population has been well investigated and documented. Blood pressure (BP) has been found to be increasing with age² the rise being steeper in men than women; after menopause women showing greater rise and reaching levels higher than men¹. Alcohol intake, body mass index and social class all are important in this context². In most non-industrialised populations rise of BP with increasing age is not an obligatory finding. A stable level of BP in adults is a common finding⁵. Migration studies have clearly documented rise of BP in populations who migrated from rural to urban areas. Various factors at play mediating rise of BP in urban setting are increased intake of calories, salt, animal proteins, saturated fat and alcohol and increased exposure to stressful events². A meta-analysis of nine major observational studies involving 4,20,000 individuals free of cardiovascular and cerebrovascular diseases at baseline and followed up for 6 to 25 years showed a direct, continuous and apparently independent association of diastolic blood pressure (DBP) with both stroke and coronary arterial disease³. Pharmacological therapy to control BP was shown in a large number of randomized controlled trials to prevent cardiovascular and cerebrovascular events such as heart attacks and strokes^4,5. Major classes of drugs used in pharmacotherapy of hypertension include, (1)Diuretics (2) Antiadrenergic Agents (3) Vasodilators (4) Angiotensin Converting Enzyme Inhibitors (5) Angiotensin Receptor Antagonists (6) Calcium Channel Blockers.      Each class has its own efficacy profile as well as characteristic adverse drug reactions. Limitations of efficacy as well as unwanted side effects associated with each class of antihypertensives has led to almost non-stop search for new drugs to treat hypertension over last five decades. Before 1950, hardly any effective and well tolerated antihypertensive was available. Veratrum and Sodium thiocyanate though capable of lowering BP, were toxic and difficult to use. Ganglion blockers (Mecamylamine) introduced in mid-fifties had unacceptable severe side effects. Reserpine also enjoyed immense popularity in fifties and sixties but caused mental depression. In sixties and seventies alpha-methyldopa, alphablockers, diuretics and clonidine ruled as antihypertensives of choice. Beta-blockers came into widespread use from mid-seventies and are one of the most popular initial antihypertensives till now. In the eighties and nineties calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors ruled the roost as antihypertensives. Angiotensin receptor antagonists and potassium channel openers are relatively recent introductions in the ever expanding armamenterium against elevated blood pressure.

METHODS

This prospective and comparative study was done to assess prescribing pattern and adverse drug reactions of anti hypertensive drugs in a tertiary care teaching hospital-Bihar. Apart from clinical efficacy, the coast effective and the safety profile of the prescribed medicine were also evaluated (ADR).

Settings

The subjects’ screening and recruitment was carried out at the Department of General Medicine, M.G.M Medical College and L.S.K Hospital, Kishanganj, Bihar. The study was carried out to the Patients those are attending at OPD, Department of General Medicine,

Study period:

The entire study starting from patient recruitment, data collection, data analysis to reporting took about one year starting from 1^st March 2015 to 31^st February2016

Study design:

The current study had been designed as a post-registration, prospective, open label study. The patients those are diagnosed as a newly hypertensive are entered in this study except those are matched with exclusion criteria. The treatment was started as per advice of the treating Physician. On next visit the other parameters like Lipid Profile, Blood Urea, Serum Creatinine, Thyroid function test, Blood Sugar, Uric Acid, ECG, Echo Cardiography, CBC, are also reviewed along with monitor of blood pressure. In case adequate control of blood pressure i.e. sitting mean diastolic blood pressure (DBP) below 90 mm Hg, And Systolic blood pressure (<140 mm Hg) was not achieved with initial dose of the prescribed medicine, the dose was increased at subsequent follow up visits. If blood pressure was not controlled by the increased dose, the optimum dose of the initial medicine was advised on subsequent follow up visit. If blood pressure was not controlled with the optimum dose of the initial medicine the patients was advised to take more than one medicines MDT to control the blood pressure. In this study, some patients who were treated with ACEI complain dry cough, some patients presented with ankle oedema those were treated with CCB, some patients complaining weakness along with muscle cramping pain those were treated with Diuretics and one patients complaining about impotency who was treated with Diuretics (Thiazied Diuretics) the prescribed initial medicine was changed accordingly as per advise of treating physician. Moreover we also review the cost effective outcome of the treatment. As we know the hypertension is not a curable disease and regular medicine is needed for life long for controle the BP. The most of the patients those are attending at the OPD were belong to Below the Poverty level, cost of the medicine is one of the most important factor which will minimize the droop out form the treatment. It was a study of pharmaco economical study also.

Study population and patient selection:

Total 500 randomly selected patients, aged from 18 to 69 yrs, those were attend in the outpatients Department of Medicine, during the study period, who are newly diagnosed as hypertensive or previously diagnosed hypertensive but not started the medication were included initially in my study. All the cases were diagnosed by the senior Professor of Medicine. Cases with diagnosed Hypertension were further evaluated on the basis of laboratory and radiological investigations for screening of Co-morbid diseases. Out of the study population, 219 patients, were selected on the basis of inclusion and exclusion criteria.

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