Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study

Abstract

Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results: A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics (P < .001). Most notably, there was a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs 11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar year 2012 than in the calendar year 2014 (P < .001). Conclusions: Antihypertensive medication use has gone through wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals.

Keywords: India; JNC 7; JNC 8; adherence; antihypertensive drugs; prescription pattern.

Figure 1.

Antihypertensive drugs compared between previous and current therapy during the year 2012 and 2014 in a retrospective cross-sectional study. Note. Other ditherapy includes BB + ARB, CCB + Diuretics, BB + ACEI, and ACEI + Diuretics. Tritherapy is defined as prescriptions with 3 active antihypertensive ingredients. P values are less than .001 which represents chi-square tests of heterogeneity comparing the respective proportions across rows between previous and current therapy during the years 2012 and 2014. ACEI = angiotensin-converting enzyme inhibitors; ARB = angiotensin receptor blockers; CCB = calcium channel blockers; BB = beta blockers; C = current therapy; P = previous therapy.