Prescribing Patterns of Antihypertensive Medications in Low- and Middle-Income Countries: A Systematic Review

Abstract

Hypertension is highly prevalent, but its pharmacological management has not been well evaluated in low- and middle-income countries (LMICs). This review examined the prescribing patterns of antihypertensives in LMICs. Data were extracted from a total of 26 studies spanning the time period 2000 to 2018. In 10 studies, calcium channel blockers (CCBs) were the most frequently prescribed medication for managing hypertension (range = 33% to 72%); in 6 studies, renin angiotensin system (RAS) blockers (range = 25% to 83%); in 5 studies, diuretics (range = 39% to 99%); and in 5 studies, β-blockers (BBs; range = 26% to 49%) were the most commonly prescribed antihypertensive medications. Prescribing sedatives and sublingual administration of captopril for controlling hypertension was also reported in 3 studies. Only 10 studies presented their findings in light of national or international guidelines. This review calls for further antihypertensive utilization and dispensation studies and a better understanding of clinician’s perception and practice of hypertension management guidelines in LMICs.

Effective Management of Hypertension: A Cross-Sectional Study of Five Health Facilities

“…Notably, two classes of antihypertensives are used for management [18]. Both calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) are predominant [12,18]. The combination of CCBs and ARBs is cost-saving [11].…”

“…This could be an informative factor for its preferred use. Ashdad reported that prescribing patterns may not occur according to guidelines in low-and middle-income countries (LMICs) [12], and this could be true, as a few discrepancies were observed in the dataset; however, because the average number of antihypertensive drugs per patient was approximately two (2), it can be said that prescribing patterns are good to some extent.…”

“…Understanding the different prescribing patterns adopted by healthcare providers is crucial for evaluating their impact on treatment outcomes, patient adherence, and healthcare resource utilization [12]. Variations in prescribing practices may stem from factors such as clinical guidelines, physician preferences, patient demographics, and drug availability, highlighting the need for comprehensive assessment and comparison of these approaches [3,12,13].…”

Challenges of managing hypertension in Pakistan - a review

“…Furthermore, smoking cessation counseling to hypertensive patients was mentioned by only 4.3% of doctors [ 69 ]. A recent systematic review on prescribing antihypertensive patterns in Pakistan, from a total of 26 studies from 2000 to 2018, concluded that only ten studies utilized national or international guidelines a better understanding of a clinician’s perception and practice of hypertension management guidelines in LMICs is needed [ 70 ].…”

Síntesis de evidencia y recomendaciones: directrices para el tratamiento farmacológico de la hipertensión arterial en adultos

“…En el Cuadro 4 se presentan algunas barreras, facilitadores y estrategias de implementación que pueden ser consideradas por los países. (16,20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) CUADRO 4. Barreras, facilitadores y estrategias para mejorar el cumplimiento de las recomendaciones…”