Management of Hypertension- Insights Into Real-World Clinical Practice for Differential Usage of Calcium Channel Blockers (Ccbs)

Abstract

BACKGROUND Calcium channel blockers (CCB) like amlodipine, S (-) amlodipine and cilnidipine, etc. have established place in the treatment of hypertension (HTN). As perceived by most of the physicians, they have comparative antihypertensive efficacy. However, available evidences suggest varied differences in incidence of pedal oedema. Aim-This survey was planned to understand real-world clinical practice pattern of Indian physicians for usage of various antihypertensive agents with emphasis on CCBs and whether differential incidence of oedema with CCBs is encountered in their clinical practice. MATERIALS AND METHODS Survey questionnaire consisting of 10 questions about preferred antihypertensive choice for different subsets of patients with HTN and efficacy and safety of S (-) amlodipine was prepared and validated in small group of physicians. Overall, 494 general physicians and cardiologists practising in India were approached for seeking their opinion on usage of various CCBs. Statistical Analysis-Data were expressed in percentage. Design-Prospective, cross sectional, questionnaire-based survey. RESULTS Amongst various anti-hypertensive agents, majority of the physicians preferred CCB as their initial drug of choice for patients with HTN (53.8%), HTN with CKD (41.1%), elderly (55.3%), and young (30.8%) patients. Though amlodipine was preferred by 75.7% physicians, pedal oedema was observed in >10% patients by 40.5% physicians. Most of the physicians rated S (-) amlodipine to have better efficacy (79.4%) and safety profile (88.3%) with decreased incidence of pedal oedema than racemic Amlodipine. CONCLUSION Available evidences suggest comparative efficacy of S (-) amlodipine and racemic amlodipine with varied differences in incidence of pedal oedema. However, our survey suggests better efficacy and safety of S (-) amlodipine over racemic amlodipine as opined by most of the physicians of India. The survey findings need to be further evaluated in randomised clinical trials.

Effectiveness of Amlodipine on Blood Pressure Control in Hypertensive Patients in India: A Real-World, Retrospective Study from Electronic Medical Records

“…The majority of the patients in the present study (90.7%) were prescribed amlodipine either as monotherapy or along with one other AHD. These findings are in line with those of earlier studies from different Indian cities [ 11 , 13 , 15 ] that reported high prescription of CCBs, with amlodipine being the drug of choice for monotherapy or as combination therapy with other AHDs. The AHDs prescribed along with amlodipine in the present study cannot be stated as we did not analyze specific AHDs or classes that were prescribed along with amlodipine.…”

“…Calcium channel blockers (CCBs) are some of the first-line agents recommended by these guidelines to combat essential hypertension. Consistent with these guidelines, multiple studies have reported the prescription of CCBs in India, either as monotherapy or in combination with other antihypertensive drugs (AHDs), to treat hypertension [ 11 – 16 ]. Moreover, among the CCBs, amlodipine was preferred by 75.7% of Indian physicians [ 11 ].…”