PRESCRIBING PATTERN AND COST EFFECTIVE ANALYSIS OF ANTI HYPERTENSIVE MEDICATIONS IN PATIENTS ATTENDING THE HYPERTENSION CLINIC AT TERTIARY CARE HOSPITAL

OBJECTIVE - To evaluate the prescribing pattern of anti hypertensive medications in patients attending the hypertension clinic at Rajiv Gandhi Government General Hospital and also to analyse cost effectiveness. METHODS - This descriptive study, evaluated the prescription of patients of either sex, aged between 30-80 years with stage 1 and 2 hypertension, being treated at the hypertension clinic, Rajiv Gandhi Govt General Hospital. Prescriptions containing anti hypertensive medications for more than 6 months were included in the study. RESULTS - Of the 578 prescriptions evaluated, following drugs were commonly precribed- T.Atenolol 50mg, T.Propranolol 10mg, T.Amlodipine 2.5mg, T.Nifedipine 5mg, T.Enalapril 2.5mg, T.Furosemide 40mg, T.Spironolactone 25mg and T.Methyl dopa 10mg, either as monotherapy (n167) or as combination therapy (n411) with 2 or more drugs. Prescriptions had 49.1 males and 50.9 females. 86.3 of the prescriptions represented stage 1 and 13.7 were stage 2 hypertension. 50 prescriptions had 2 drug combination therapy followed by monotherapy, which was 29. 3 drug and 4 drug combination therapy were 18 and 3 respectively. A total of 65.92 of prescriptions contained T.Amlodipine in both the single and combination therapy followed by T.Atenolol (64.36) and T.Enalapril (50.69). T.Nifedipine (0.34), T. Spironolactone (0.34) and T.Propranolol (0.34) were least prescribed drug in monotherapy and combination therapy. Total annual drug expentiture for all groups of antihypertensives was Rs.63,334.80, of which around 50 was spent on T.Amlodipine and T.Atenolol.CONCLUSION -Although CCBs, beta-blockers and ACEIs were the most frequently prescribed antihypertensive agents, alpha-blockers and diuretics were prescribed sparingly. Among different classes of antihypertensive agents specific drugs like amlodipine, atenolol and enalapril occupied large proportion of the prescription. Cost is an important consideration for therapy An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Pre and Para Clinical Sciences of a chronic disease like hypertension, often requiring lifelong medication. Keyword :Key words Hypertension, prescribing pattern, cost of drugs. INTRODUCTION Hypertension (HTN) is the term used to denote elevated blood pressure (BP). It is defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure (SBP) above 140 with a diastolic pressure (DBP) above 90. Hypertension is an important public health challenge because of the associated morbidity and mortality and the cost to society.[1] It is estimated that the worldwide prevalence of hypertension would increase from 26.4% in 2000 to 29.2% in 2025.[2] The reported prevalence of HTN varied around the world with the lowest in rural India (3.4% in men and 6.8% in women) and the highest in Poland (68.9% in men and 72.5% in women).[2] [3] Hypertension is classified as either primary (essential) hypertension or secondary hypertension. About 90?95% of cases are categorized as "primary hypertension," which is a multifactorial disease with no obvious medical cause. The remaining 5?10% of cases are secondary hypertension, which is caused by other conditions that affect the arteries, kidneys, heart or endocrine system. According to the Joint National Committee (JNC) 7 criteria, systolic BP between 140 and 159 mm Hg or diastolic BP between 90 and 99 mm Hg are considered to be stage 1 hypertension whereas systolic BP >160 mm Hg or diastolic BP >100 mm Hg are considered to be stage 2 hypertension.[4] There are many agents available to treat HTN, each targeting a different pathophysiologic aspect. Stage 1 hypertension is managed with monotherapy while stage 2 hypertension requires 2 or more drugs to control the BP. Usually, pharmacological treatment is started as monotherapy, which if unsuccessful, is followed by the combination of 2 or more drugs. Adjusting the dose