Study on appropriate and rational drug use in hypertensive patients with other comorbid diseases

Abstract

Hypertension is one of the major chronic diseases resulting in high mortality and morbidity worldwide. It is a leading risk factor for coronary heart disease, stroke and chronic renal disease. There are many classes of antihypertensive available. Rational prescribing is essential as hypertension is highly prevalent and therapy is chronic. Health care professionals need to utilise limited resources wisely in order to provide effective, safe and affordable antihypertensive therapy. The objective of the study is to determine the appropriateness and rationality of antihypertensive drugs in the selected study population as per our inclusion criteria. The data were collected from regular ward rounds and they were analysed. The appropriateness was analysed using the JNC-7 guidelines. A total of 97 patients were included in our study, their prescriptions were analyzed. The age categorization reveals that majority of patients were above 40 years. The analysis of risk factors associated with hypertension shows that 33 (34.02%) patients were smokers, 30 (34.39%) patients were alcoholics and 36 (37.11%) patients were found to be with BMI >30. The total numbers of antihypertensive drugs prescribed in the study population was found to be 156. It was found that ?-blockers were the most commonly prescribed in 41 (26.28%) patients, followed by CCBI (Dihydropyridines) in 33 (21.15%) patients. The total numbers of inappropriately prescribed drugs were found to be 29 (18.59%) and they were found to be prescribed in contraindicated co-morbid conditions. Among the inappropriately prescribed drugs 11 (37.93%) drugs of ACE inhibitors were found to be contraindicated in renal failure patients, 9 (31.03%) diuretics were contraindicated in dyslipidaemic patients, 6 (20.69%) beta blockers were contraindicated in asthmatics and 3 (10.34%) ARB’s were contraindicated in patients with renal failure & hyperkalemia. The rationality of prescribed drugs was analyzed; the results reveals that 138 (88.46%) drugs prescribed were found to be rational and 18 drugs (11.54%) prescribed were irrational. The irrational prescription drugs were analyzed and it was found that 8 (44.44%) prescriptions contain drugs from same class, 6 (33.33%) with increased frequency of dose and 4 (22.22%) prescription with over dose. The results reveal continuous monitoring of the prescribing of antihypertensive agents by the clinical pharmacist is necessary to resolve the issues of inappropriateness and enhancement of rational prescribing. The clinical pharmacist has the greater responsibility in monitoring of hypertensive patients with other co-morbid conditions.