Patterns of utilization of antihypertensive drug combinations in Bahrain: do they conform with international guidelines?

Evaluation Clinical Practice

Khaja

Damanhori

2004

According to the WHO/ISH 1999 guidelines, approximately one out of 10 diabetic hypertensives achieved target BP control. In many instances, the drug therapy prescribed was inappropriate considering the comorbidity in patients and their laboratory findings. Improved BP control is needed in treating high-risk groups such as patients with diabetes mellitus, and efforts should be made to improve the treatment of hypertension in the primary care setting.

Section: Discussionmentioning

confidence: 99%

Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?

Evaluation Clinical Practice

Khaja

Damanhori

2004

“…2001), although conformity with these guidelines is suboptimal (Ribacke 1995; Daniels et al. 2000; Al Khaja et al. 2000, 2001a); perhaps this is partly due to the complexity of the guidelines (Brook 1989; Ribacke 1995; McAlister et al.…”

Section: Discussionmentioning

confidence: 99%

“…We have reported earlier antihypertensive drug‐prescribing patterns of primary care physicians in Bahrain in uncomplicated hypertension (Al Khaja et al. 2000, 2001a) and in diabetic hypertension (Al Khaja et al.…”

Section: Introductionmentioning

confidence: 95%

Prescribing pattern of antihypertensive drugs by family physicians and general practitioners in the primary care setting in Bahrain

Evaluation Clinical Practice

Jassim

Damanhori

et al. 2002

The aim was to determine whether there are differences among family physicians (FPs) and general practitioners (GPs) in terms of their preference for different classes of antihypertensives, either alone or in combinations, in uncomplicated cases of hypertension and to determine the extent of adherence to WHO/ISH guidelines. We have analysed prescribing of antihypertensives by qualified family physicians (FPs) (n=77) and compared this with that of general practitioners (GPs) (n =41) by auditing 1791 prescriptions of FPs and 914 prescriptions of GPs, issued to patients with uncomplicated hypertension, at 15 out of 20 health centres in Bahrain. The choice of antihypertensive(s) by FPs and GPs was comparable and conformed with the WHO/ISH guidelines as regards preference for: (i) beta-blockers, angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) as monotherapy; (ii) two-drug combinations (diuretic-beta-blocker; beta-blocker-CCB); (iii) three-drug combinations (diuretic-beta-blocker-CCB; diuretic-beta-blocker-ACE inhibitor; beta-blocker- ACE inhibitor-CCBs), and (iv) choice of drug used for the elderly either alone (CCBs) or as combinations (diuretic-beta-blocker; beta-blocker-CCB and diuretic-beta-blocker-ACE inhibitor; diuretic-beta-blocker-CCB). In several instances prescribing by both FPs and GPs was not in accordance with the WHO/ISH guidelines: reluctance to prescribe diuretics as monotherapy; use of suboptimal combinations (beta-blocker-ACE inhibitor); and extensive use of beta-blockers and irrational use of immediate-release nifedipine in elderly. A statistically significant prescribing difference between FPs and GPs was evident in the following: beta-blockers as monotherapy (P =0.01), diuretic-CCB (P=0.046), and diuretic-CCB-methyldopa (P=0.01) combination, and immediate-release nifedipine monotherapy in the elderly (P=0.027), were prescribed more often by the GPs. However, beta-blocker-ACE inhibitor-CCB combination was more often prescribed by FPs (P=0.046). Remarkable differences in prescribing pattern of antihypertensives between the FPs and GPs were evident. Although the general pattern supported a superior prescribing profile of the FPs as expected, there is a need for improved prescribing by both GPs and FPs. Educational programmes, both graduate and residency training, and continuing professional education, should specifically address these deficiencies in order to assure quality primary health care.

“…The detailed methodology, including the organization of the healthcare system in Bahrain, has been described earlier. 15 hypertension. The proportion and frequency of patients receiving antidiabetic drugs are summarized in Table 1.…”

Section: Variabilitymentioning

confidence: 99%

Prescribing Patterns and Therapeutic Implications for Diabetic Hypertension in Bahrain

Khaja

Mathur³

2001

Ann Pharmacother