Antihypertensive Prescription Patterns and Blood Pressure Control in Patients With Hypertension At A Tertiary Care Hospital

Abstract

Background: Hypertension is a major contributor to cardiovascular and cerebrovascular morbidity and is frequently accompanied by metabolic and other cardiovascular risk factors. Although several effective antihypertensive drugs are available, adequate blood pressure control remains suboptimal in many patients. Evaluation of treatment patterns in routine clinical practice can provide useful information about commonly used antihypertensive regimens and the extent of blood pressure control.

Aim: To assess antihypertensive prescription patterns and blood pressure control among adults with established hypertension attending a tertiary-care hospital.

Methods: A cross-sectional observational study was conducted among 384 adults with known hypertension attending the Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai. Patients aged ≥18 years who had been receiving stable antihypertensive treatment for at least one month were eligible. Newly diagnosed hypertensive patients and those receiving antihypertensive therapy irregularly were excluded. Demographic characteristics, associated comorbidities and antihypertensive treatment regimens were recorded. Patients were classified according to whether they received monotherapy, dual therapy or triple therapy. Blood pressure control was assessed using the criteria of the Eighth Joint National Committee (JNC 8).

Results: Of the 384 participants, 215 (56.0%) were males and 169 (44.0%) were females. Patients aged 51–60 years constituted the largest age group (36.0%). Monotherapy was prescribed in 154 (40.1%) patients, dual therapy in 134 (34.9%) and triple therapy in 96 (25.0%). Calcium channel blockers were the most frequently prescribed agents among patients receiving monotherapy. CCB + ARB was the most frequently observed dual-drug combination, while CCB + ARB + diuretic was the most frequently observed triple-drug regimen. Overall, 242 (63.0%) patients had controlled blood pressure and 142 (37.0%) had uncontrolled blood pressure. BP control was observed in 57.1% of patients receiving monotherapy, 64.2% receiving dual therapy and 70.8% receiving triple therapy. The difference in BP-control status across treatment-intensity groups was not statistically significant (χ²=4.87, p=0.087).

Conclusion: Combination antihypertensive treatment was frequently used in this tertiary-care population. Calcium channel blocker-containing regimens constituted an important component of antihypertensive prescribing. Although the proportion of patients with controlled BP was highest among those receiving triple therapy, the observed difference between treatment groups did not reach statistical significance.