Antihypertensive Prescription Pattern and Associated Medication Costs: A Retrospective Review of Prescriptions in A Tertiary Hospital
DOI:
https://doi.org/10.22270/ajprd.v7i5.580Keywords:
Hypertension, cardiovascular disease, Antihypertensive, antihypertensive prescription, morbidityAbstract
Background: Hypertension is the leading cardiovascular disease most associated with high risk of morbidity and mortality. Recent evidence indicate that in low and medium income countries hypertension is a growing healthcare challenge compounding already existing high burden of infectious diseases. The overall goal of treatment is to reduce the risk of associated secondary complications which increases the risk of mortality. The choice of antihypertensive medications vary widely between and within health facilities, however concerns remain whether prescribed drugs affordable as well as optimize treatment outcomes.
Aim: The aim of this study is to determine antihypertensive prescription pattern and its impact on affordability of drug treatment
Results/Discussions: The results showed that monotherapy with CCBs were the most prescribed drugs accounting for over half of all antihypertensive prescriptions. In addition CCB based combination therapies were found in more than three quarters of all prescriptions. The cost of one month supply of innovator brands was significantly higher than generic versions, which made them far less affordable to majority of patients. The prescription pattern did not significantly adhere to current treatment guidelines for the management of hypertension. This makes the case for improvement in prescription practices that emphasize rational drug therapy that take into cognizance costs, particularly among the poor.
Conclusion: Antihypertensive prescription pattern did not largely comply with guidelines and the widespread prescription of innovator drug brands makes medicines largely unaffordable to majority of patients. It is imperative that drug treatment of high blood pressure allow patients to benefit from reduced cost of low priced generic drugs.
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References
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36. Karve AV, Chatter KB. Cost analysis study of oral antihypertensive agents available in Indian markets. Int J Basic ClinPharmacol 2014; 3:479 – 483
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39. Osibogun A, Okwor T. Antihypertensive prescribing and cost patterns in an outpatient department of a teaching hospital in Lagos State, Nigeria. Op Prev Med Prev Med 2014; 4:156 – 163.
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46. Shipra J, Prerna U, Jaswant G, Kumar A, Pushpawati J, Vikas S et al. A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines. PerspectClin Res 2015; 6:86 – 90.
47. Xavier D, Noby M, Pradeep J, Prem P. Pattern of drug use in hypertension in a tertiary hospital: a cross sectional study in the in patients ward. Indian J Pharmacol 2001; 33:456 – 457.
48. Gu Q, Burt VL, Dillon CF, Yoon S. Trend in antihypertensive medication use and blood pressure control among United States adults with hypertension. The national health and nutrition examination in survey 2001 to 2010. Circulation 2012; 126(17):2105 – 2114.
49. Bakare OQ, Akinyinka MR, Goodman O, Kuyinu YA, Adeniran A, Odusanya OO, Osibogun A. Antihypertensive use, prescription pattern and cost of medications in a teaching hospital in Lagos, Nigeria. Niger J ClinPract 2016; 19: 668 – 672.
50. Katibi IA, Olarinoye JK. Antihypertensive therapy among hypertensive patients as seen in the middle belt of Nigeria. Ann Afr Med 2004; 4: 177 – 180
51. Adejumo O, Okaka E, Iyawe I. Prescription pattern of antihypertensive medication and blood pressure control among hypertensive outpatients of the University of Benin teaching hospital in Benin City, Nigeria. Malawi Med J 2017; 29(2): 113 – 117.
52. Oga OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJC, Falase AO et al. Blood pressure prevalence of hypertension and hypertension related complications in Nigerian Africans. A review. World J Cardiol 2012; 4(12): 327 – 340.
53. Mishra R, Kesarwani P, Keshari SS. Prescription pattern of antihypertensive drugs in a tertiary care teaching hospital. Int J Med Sci Public Health 2017; 6(4):684 – 686.
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2. Kearney PM, Whelton M, Reynolds K, Munter P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005; 365(9455):217 – 223.
3. Lim SS, Vos T, Flaxman AD, Danaci 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 review for the global burden of disease study 2010. Lancet 2012; 380(9859):2224 – 2260.
4. Oladapo OO, Falase AO, Salako L, Sodiq O, Shoyinka K, Adedapo K. A prevalence of cardiometabolic risk factors among a rural Yoruba South Western Nigerian population: a population based survey. Cardiovasc J Afr 2010; 21(1):26 – 31.
5. Ofuya Z. The incidence of hypertension among a select population of adults in the Niger Delta region of Nigeria, Southeastern Asian J Trop Med Public Health 2007; 38(5):947 – 949.
6. Adedoyin RA, Mbada CE, Balogun MO, Martins T, Adebayo RA, Akintomide A et al. Prevalence and pattern of hypertension in a semi urban community in Nigeria. Eur J CardiovascPrevRehabil 2008; 15(6):683 – 687.
7. Oladipo BA. Current epidemiology of hypertension in Nigeria. Arch Ibadan Med 2001; 1(1): 4 – 8.
8. Kochen TA. Hypertensive vascular disease. In : Fauci AS, Braunwal EB, Kasper DL, Hauser SL, Longo DL, Jameson JL editors. Harrisons principles of internal medicine. 17th edition. New York. McGraw Hill Inc 2008; 1549 – 1562.
9. Altaf M, Rasheed A, Mujtaba A, Mohammed S. Drug utilization evaluation of antihypertensives in geriatric patients in a tertiary care hospital. Int J Pharm Sci 2014; 6(9):261 – 264.
10. Gupta R. Trends in hypertension epidemiology in India. J Human hypertens 2004; 18:73 – 78.
11. WHO 2008. World Health Organization. Causes of death 2005. http://www.who.int/global_burden_diseases_/cod_2008_sources_methods.pdfAccessed 3/4/19
12. World Health Organization. Global status report on non-communicable diseases 2010. Geneva. World Health Organization 2011.
13. James PA, Oparil S, Carter BL, Cushman WC, Denninson-Himmerlfarb C et al. Eight joint national committee [JNC8]. Evidence based guidelines for the management of high blood pressure in adults: reports from the panel members appointed to the eight joint national committee [JNC8] Supplemental content. JAMA 2014; 311(5):507 – 520.
14. Kabir Z, Feely J, Bennett K. Primary care prescribing pattern in Ireland after the publication of large hypertension trials. Br J ClinPharmacol 2007; 64:381 – 385.
15. Busari OA, Olanrewaju TO, Desalu OO, Opadijo GO, Jimoh AK, Agboola SM, Busari OE et al. Impact of knowledge attitudes and practices on hypertension on compliance with antihypertensive drugs in a poor resource setting. TAF Prevent Med Bull 2010; 9(2):87 – 92.
16. Psaty BM, Manolio TA, Smith NL, Heckbert SR, GoldienerJS ,Burke GL et al. Time trends in high blood pressure control and use of antihypertensive medications in older adults: The cardiovascular Health study. Arch Int Med 2002; 162:2325 – 2332.
17. Primastesta P, Brookes M, Poulter NR. Improved hypertension management and control: result from the health survey for England 1998. Hypertens 2001; 3:827 – 832.
18. Olanrenwaju TO, Aderibigbe A, Busari OA, Sanya ED. Antihypertensive drug utilization and conformity to guidelines in a sub – Saharan African hypertensive population. Int J ClinPharmacolTher 2010; 48(1):68 – 75.
19. Romday R, Gupta AK, Bhambani P. An assessment of antihypertensive drug prescription pattern and adherence to joint national committee -8 hypertension treatment guidelines among hypertensive patients attending a tertriary care teaching hospital. Int J Res Med Sci. 2016; 4(12): 5125 – 5133.
20. Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure lowering efficacy of monotherapy with Thiazides diuretics for primary hypertension. Cochrane database Syst Rev 2014; 5: CD003824.
21. Shrank WH, Hoang T, Ettner SL, Glassman PA, Nair K, Delapp D, Dirstine J, Avorn J, Arsh SM. The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med 2006; 166(3):332 – 337.
22. Al-Drabah E, Irshald Y, Yasein N, Zmeill S. Prescription pattern of antihypertensive drugs in family practice clinics at Jordan University Hospital. Med Sci 2013; 2(1):469 – 488.
23. Theodorou M, Stafylas P, Kourlaba G, kaitelidou D, Maniadakis N, Papademetriou V. Physicians perceptions and adherence to guidelines for the management of hypertension: a national multicenter, prospective study. Int J Hypertens 2012.
24. Oluseyi A, Enajite O, Ikponmwosa I. Prescription pattern of antihypertensives medications and blood pressure control among hypertensive outpatients at the University of Benin teaching hospital in Benin City, Nigeria. Malawi Med J. 2017; 29(2):113 – 117.
25. Neal B, MacMahons S, Chapman N. Effects of ACE inhibitors, Calcium antagonists and other blood pressure lowering drugs: Results of prospectively designed overviews of randomized trials. Blood pressure lowering treatment trialists collaboration. Lancet 2000; 356:1955–1964.
26. Lemogoum D, Seedat YK, Mabadeje AFB, Mendis S, Bovet P, Onwubere B et al. Recommendation for prevention, diagnosis and management of hypertension and cardiovascular risk factors in sub Saharan Africa. J Hypertens 2003; 21:1993 – 2000.
27. Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grim RH et al. Success and predictors of blood pressure control in diverse north American settings. The antihypertensive and lipid lowering treatment to prevent heart attack trial [ ALLHAT]. J ClinHypertens 2002; 4:339 – 340.
28. Tamuno I, Babashani M. Blood pressure control among hypertensive patients in a tertiary healthcare facility in Northern Nigeria. Res J Med Sci 2012; 6(1):26 – 32.
29. Sharma AK, Dahiya N, Kairi JK, Bharati SM. Prescription patterns of antihypertensive drugs in a tertiary care hospital in India. Int J Basic ClinPharmacol 2015; 4:55 – 59.
30. Janagan T, Kavitha R, Sridevi SA, Veerendra V. Prescription pattern of antihypertensive drugs used in hypertensive patients with associated type 2 diabetes mellitus in a tertiary care hospital. Int J Pharm Res Rev 2014; 3(1):1 – 5.
31. Kaur S, Gupta S, Kumar D, Lal M, Gilani Z. Prescribing pattern of antihypertensive drugs in a tertiary care hospital in Jammu- A descriptive study. JK – Practitioner 2012; 17(4):38 – 41.
32. Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. TherClin Risk Manage 2013;9:115 – 120.
33. Okhuelegbe ES, Odili VU, Iwuagwu MA, Igodo JO. Prescription pattern of antihypertensives and drug utilization in a general hospital Minna, Niger State, Nigeria. Pak J Pharm 2012; 25(1 and 2):37 – 41.
34. Hussain Z, Sana A, Mohammed S, Razzaq MA. Patterns of drug therapy among diabetic hypertensive patients with other complications. Int J Pharm PharmSci 2014; 6(6):270 – 277.
35. St. Peter WL, Sozio SM, Shafi T, Ephraim PL, Luly J, McDevmottA et al. Pattern in blood pressure medication use in United States incident dialysis patients over the first 6 months. BMC Nephrol 2013; 14:249.
36. Karve AV, Chatter KB. Cost analysis study of oral antihypertensive agents available in Indian markets. Int J Basic ClinPharmacol 2014; 3:479 – 483
37. Sipla R, Helin-Salmivaara A, Korhonen MJ, Ketola E. Change in antihypertensive drug prescribing after guideline implementation: A controlled before and after study. BMC Family Practice 2011; 12: 87.
38. Fischer MA, Avom J. Economic implication of evidence based prescribing for hypertension: Can better care cost less? JAMA 2004; 291(15):1850 – 1856.
39. Osibogun A, Okwor T. Antihypertensive prescribing and cost patterns in an outpatient department of a teaching hospital in Lagos State, Nigeria. Op Prev Med Prev Med 2014; 4:156 – 163.
40. Rimoy GH, Justin-Tenu M, Nilay C. Prescribing patterns and cost of antihypertensive drugs in private hospitals in Dar es Salam, Tanzania. East Cent Afr J Pharm Sci 2008; 11:69 – 73.
41. Amira CO, Okubadejo NU. Antihypertensive pharmacotherapy in a developing economy, pattern, acquisition costs and conformity to international guidelines in a tertiary care setting. J Human Hypertens 2006; 20:894 – 897.
42. Rachana PR, Anuradha HV, Shivamurthy MC. Antihypertensive prescribing patterns and cost analysis for primary hypertension. A retrospective study. J ClinDiagn Res 2014;8(9):19 – 22.
43. Abdulameer SA, Sahib MN, Aziz NA, Hassan Y, Abdul HA, Razzaq A et al. Physician adherence to hypertension guidelines and drug acquisitions costs antihypertensive drugs at the cardiac clinic : A pilot study. Patient Preferance and Adherence 2012; 6:101 – 108.
44. Ahmad N, Hassan Y, Tangiisuran B, Meng OL, Abdaziz N, Khan AH. Guideline adherence and hypertension control in an outpatient cardiology clinic in Malaysia. Trop J Pharm Res 2012; 7(2): 665 – 672.
45. Odili VU, Oghagbon EK, Ugwa NA, Ochei UM, Aghomo OE. Adherence to international guidelines in the management of hypertension in a tertiary hospital in Nigeria. Trop J Pharm Res 2008; 7(2):945 – 952.
46. Shipra J, Prerna U, Jaswant G, Kumar A, Pushpawati J, Vikas S et al. A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines. PerspectClin Res 2015; 6:86 – 90.
47. Xavier D, Noby M, Pradeep J, Prem P. Pattern of drug use in hypertension in a tertiary hospital: a cross sectional study in the in patients ward. Indian J Pharmacol 2001; 33:456 – 457.
48. Gu Q, Burt VL, Dillon CF, Yoon S. Trend in antihypertensive medication use and blood pressure control among United States adults with hypertension. The national health and nutrition examination in survey 2001 to 2010. Circulation 2012; 126(17):2105 – 2114.
49. Bakare OQ, Akinyinka MR, Goodman O, Kuyinu YA, Adeniran A, Odusanya OO, Osibogun A. Antihypertensive use, prescription pattern and cost of medications in a teaching hospital in Lagos, Nigeria. Niger J ClinPract 2016; 19: 668 – 672.
50. Katibi IA, Olarinoye JK. Antihypertensive therapy among hypertensive patients as seen in the middle belt of Nigeria. Ann Afr Med 2004; 4: 177 – 180
51. Adejumo O, Okaka E, Iyawe I. Prescription pattern of antihypertensive medication and blood pressure control among hypertensive outpatients of the University of Benin teaching hospital in Benin City, Nigeria. Malawi Med J 2017; 29(2): 113 – 117.
52. Oga OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJC, Falase AO et al. Blood pressure prevalence of hypertension and hypertension related complications in Nigerian Africans. A review. World J Cardiol 2012; 4(12): 327 – 340.
53. Mishra R, Kesarwani P, Keshari SS. Prescription pattern of antihypertensive drugs in a tertiary care teaching hospital. Int J Med Sci Public Health 2017; 6(4):684 – 686.
54. Kuchake VG, Maheshwani OD, Surana SJ, Patil PH, Digboe PN. Prescription pattern of antihypertension drugs in uncomplicated hypertensive patients at a teaching hospital. Indian J Pharm Pract 2009; 2(2):74 – 80.
55. Olanrewaju TO, Aderibigbe A, Chijioke A, Sanya EO, Busari OA, Kolo PJ et al. Descriptive analysis of blood pressure control among treated hypertensive patients in a tertiary hospital in Nigeria. Afr J Med MedSci 2011; 40(3):207 – 212.
56. Busari OA, Oluyombo R, Fasae AJ, Gabriel EO, Ayodele LM, Agboola SM et al. Prescribing pattern and utilization of antihypertensive drugs and blood pressure control in adults patients with systemic hypertension in a rural tertiary hospital in Nigeria. Am J Intern Med 2014; 2(6):144 – 149.
57. Ekwunike OI, Ubaka CM. Drug utilization, antihypertensive therapy among patients with compelling indications in two hospitals in south eastern Nigeria. J Pharm pharmacol Res 2011; 2: 25 – 28.
58. Etuk E, IsezuoSA, Chika A, Akuche J, Ali M. Prescription patterns of antihypertensive drugs in a tertiary health institution in Nigeria. Ann Afr Med 2009; 7:128 – 132.
59. Yusuff KB, Balogun O. Physicians prescribing pattern of antihypertensive combinations in tertiary care setting in South Western Nigeria. J Pharm Sci 2005; 4(8):235 – 342.
60. Salako BL. Blood pressure control in the Sub Saharan Africa; a physician’s perspective. Post Grad Doct 2004; 25:4
61. Okonta JM, Nduka V, Idodo VE. Prescribing pattern of antihypertensives and antidiabetic agents in a secondary healthcare institution in Nigeria. J Pharm Sci Res 2012; 5:2 – 17.
62. Ukwe CV, Ubaka CM. Antihypertensive drug prescribing in a tertiary hospital in eastern Nigeria. Trop J Pharm Res 2012; 11:297 – 305
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Published
2019-10-15
How to Cite
Paul, O. O., Kaigama, A., & Abdulmalik, A. (2019). Antihypertensive Prescription Pattern and Associated Medication Costs: A Retrospective Review of Prescriptions in A Tertiary Hospital. Asian Journal of Pharmaceutical Research and Development, 7(5), 12–18. https://doi.org/10.22270/ajprd.v7i5.580
Issue
Section
Research Articles
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