Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population

Olanrewaju, T O; Aderibigbe, AO; Busari, Olusegun Adesola; Sanya, E O

doi:10.5414/cpp48068

Cited by 20 publications

(31 citation statements)

References 30 publications

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“…In a study by Zaveri et al in India, 40.3% of the prescribed drugs were antihypertensives 34. Calcium channel blockers (10.5%) and diuretics (10.4%) were the most prescribed antihypertensives among these patients, a finding consistent with another Nigerian study on drug use in hypertension 37. At variance with our findings are the results from a study in India, in which the beta-blocker Atenolol was the most prescribed antihypertensive 34.…”

Section: Discussionsupporting

confidence: 82%

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital

Fadare¹,

Agboola²,

Opeke³

et al. 2013

TCRM

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IntroductionPolypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria.MethodologyThis was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications.ResultThe medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline.ConclusionPolypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.

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Section: Discussionsupporting

confidence: 82%

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital

Fadare¹,

Agboola²,

Opeke³

et al. 2013

TCRM

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“…angiotensin-converting enzyme inhibitors concentrate almost three quarters of the prescriptions although beta-blockers (26.5%) and thiazide diuretics (19.8%) still had an important share. This pattern of prescriptions for antihypertensives had been previously observed in Mexico [7] and, taking into consideration the evolution in time, with some variation, is quite coincidental with that observed in other diverse countries such as Peru [11], Turkey [12], Portugal [13], Nigeria [14], Trinidad [15], Sweden [16] or Spain [17]. Thus, the current pattern of antihypertensive use in most of the countries would be that of a decline in the traditionally recommended medications, diuretics and beta-blockers, and an increase in newer medications such as ACEIs and ARBs; calcium-channel blockers would have a marginal role in this pattern.…”

Section: Discussionsupporting

confidence: 81%

Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study

Alba-Leonel

Carvajal

Fierro

et al. 2016

Fundamemntal Clinical Pharma

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Hypertension is highly prevalent; in Mexico, the 2012 National Health and Nutrition Survey reported a prevalence of hypertension of 31.5% in the adult population. Pharmacological treatment is the commonest intervention and has been shown to reduce cardiovascular mortality and morbidity, and total mortality. Accordingly, the type and number of antihypertensives used and the outcome — in terms of blood pressure (BP) control — are important. Therefore, our purpose is to learn the pattern of antihypertensive drug prescription and explore the determinants of BP control in an urban population in Mexico. A retrospective cross‐sectional drug utilization study was conducted. Medical records from a community health centre were searched to identify those corresponding to patients diagnosed with hypertension; information upon antihypertensives used and control of the disease was carefully retrieved. A logistic regression model was built to know the main determinants of BP control. A sample of 345 clinical records of interest was identified. Most patients received antihypertensives (86.4%); the leading medications used were angiotensin‐converting enzyme inhibitors, 63.8%; beta‐blockers (26.5%), diuretics (19.8%), angiotensin‐receptor blockers (15.8%) and calcium‐channel blockers (6.4%). Only the age (≥55 years) and BMI (>30) of the patients, and the age of the doctors (≥55 years), had an important influence on BP control. Obesity is a particular and important determinant of uncontrolled hypertension; it is worth to act on body weight, on an individual basis. As lack of control has been also tied to elderly doctors, an education programme could be envisaged.

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“…[21] Among antihypertensives, angiotensin receptor blockers (ARBs) (47%) and calcium channel blockers (CCBs) (21.2%) were the most prescribed to the patients, a finding consistent with a Nigerian study carried out on drug use in hypertension in which diuretics (84%), CCBs (66%), and angiotensin-converting enzyme inhibitors (ACEIs, 65%) were common. [22] Atenolol (beta blocker) was the most prescribed antihypertensive in an Indian study[21] and this finding is not consistent with our study. This may be due to the change in recent guidelines for treatment of hypertension according to the Eighth Joint National Committee on Hypertension in which beta blockers are the second-line drugs.…”

Section: Discussioncontrasting

confidence: 95%

Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India

Shah

Joshi

Christian

et al. 2016

J Basic Clin Pharma

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Aims:The aim of this study is to evaluate potentially inappropriate medications (PIMs) in the elderly at cardiology outpatient department (OPD) of a tertiary care teaching hospital using Beers criteria and to find the direct cost burden of PIMs.Materials and Methods:The present study was an observational cross-sectional study. Prescriptions of the patients’ aged ≥65 years were collected from the cardiology OPD and were analyzed. PIMs were identified with the help of Beers 2012 criteria. Direct costs of prescribed drugs were calculated. Predictors (comorbid conditions, number of drugs prescribed) associated with PIM use were identified using bivariate analysis. Multivariate logistic regression was then applied to study the influence of these variables on PIM use. A P < 0.05 was considered statistically significant.Results:A total of 236 patients received 1443 drugs. According to Beers 2012 criteria, 29.3% patients received at least one PIM followed by two and three PIMs in 10 and 23 patients, respectively. The most commonly prescribed PIM was spironolactone in 15.7% patients followed by benzodiazepines in 15 patients. The total cost of therapy for 1 day was Indian Rupee (INR) 10,029.2 while total cost of all prescribed medications in per day was INR 42.5.Conclusions:This study showed higher use of PIMs among the elderly in cardiac OPD. It is important to improve the situation of older cardiac patients who have higher use of PIMs. In older patients, high prevalence of PIMs was associated with increased cost. The use of regular continuing medical education program by the hospital and educating and training doctors on rational prescribing will help alleviate this issue.

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Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population

Cited by 20 publications

References 30 publications

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital

Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital

Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study

Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India

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