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Antihypertensive drug utilization at health centres in a district of Istanbul

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Abstract

Objective

Since irrational use of antihypertensives has considerable clinical and economical consequences, this study was conducted to evaluate antihypertensive drug utilization in hypertension at seven State Health Centres in Istanbul.

Method

A total of 297 hypertensive patients who accepted to␣participate in the study were evaluated by a face-to-face questionnaire and a copy of their prescriptions were collected for prescription analysis.

Results

Angiotensin-converting enzyme (ACE) inhibitors (31.7%), calcium channel blockers (28.8%), diuretics (16.2%), beta blockers (7.5%) and others (15.8%) have been prescribed. There were no statistically significant relation between prescribed antihypertensive drug groups and gender, age, and NSAIDs co-prescribing. The most frequent comorbidity in hypertensive patients was diabetes mellitus (10.4%) and calcium channel blockers (35.5%) have been prescribed to them as a first antihypertensive medication. Average cost per prescription was $ 42.7±38.1. According to the patients’ self-reporting, the majority of them (85%) were prescribed without a physical examination. The physicians failed to write the prescriptions appropriately; only 5% of the scripts contained all information about the drug(s) and use instructions in full format.

Conclusion

The present study indicates that GPs working at primary healthcare centres were rational in terms of antihypertensive drug choice. However, they poorly applied rational pharmacotherapy principles such as (a) writing a “good” prescription which is easily readable by the pharmacist and the patient and that contains full essential information; (b) a medical examination of the patient to assess her/his current clinical condition; and (c) taking care of not prescribing drugs with potential interaction like antihypertensives and NSAIDs together.

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References

  1. Guidelines Subcommittee World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. J Hypertens 1999; 17:151–183

    Google Scholar 

  2. Education Program Coordinating Committee The Sixth Report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157:2413–2446

    Article  Google Scholar 

  3. Onat A, Sansoy V. Systolic and diastolic blood pressure related to six other risk parameters in Turkish adults: strong correlation with relative weight. Int J Cardiol 1998; 63:295–303

    Article  PubMed  CAS  Google Scholar 

  4. Aydemir O, Ozdemir C, Koroglu E. The impact of co-morbid conditions on the SF-36: a primary-care-based study among hypertensives. Arch Med Res 2005; 36(2): 136–141

    Article  PubMed  Google Scholar 

  5. Altan Onat, editor. Heart Health, Risk Profile and Heart Disease among Turkish Adults. TEKHARF Study. August 2000, Istanbul. ISBN: 975-596-016-3

  6. Giles TD. Pharmacoeconomic issues in antihypertensive therapy. Am J Cardiol 1999; 84:25K–28K

    Article  PubMed  CAS  Google Scholar 

  7. Calvo-Vargas CG, Carrillo JZP, Paez FG, Reyes SF. Changes in the cost of antihypertensive medications in a developing country. A study in Mexico comparing 1990 and 1996. Am J Hypertens 1998; 11:487–493

    Article  PubMed  CAS  Google Scholar 

  8. Rizzo JA, Simons WR. Variations in compliance among hypertensive patients by drug class: implications for health care costs. Clin Ther 1997; 19(6):1446–1457

    Article  PubMed  CAS  Google Scholar 

  9. Avanzini F, Alli C, Colombo P, Corsetti A, Colombo F, Tognoni G. Control of hypertension in Italy: results of the “study on antihypertensive treatment in general practice. (STAP)”. Physicians taking part in STAP. G Ital Cardiol 1998; 28:760–766

    Google Scholar 

  10. Faulhaber HD, Luft FC. Treatment of high blood pressure in Germany. Am J Hypertens 1998; 11:750–753

    Article  PubMed  CAS  Google Scholar 

  11. Sequeira RP, Al Khaja KA, Damanhori AHH, Mathur VS. Prescribing pattern of antihypertensive drugs by family physicians and general practitioners in the primary care setting in Bahrain. J Eval Clin Pract 2002; 8(4):407–414

    Article  PubMed  Google Scholar 

  12. Pardell H, Tresserras R, Armario P, Hernandez R. Actions implemented to improve hypertension control in Spain. Am J Hypertens 1998; 11:763–765

    Article  PubMed  CAS  Google Scholar 

  13. Gasse C, Stieber J, Döring A, Keil U, Hense HW. Population trends in antihypertensive drug use: results from the MONICA Augsburg Project 1984 to 1995. J Clin Epidemiol 1999; 52(7):695–703

    Article  PubMed  CAS  Google Scholar 

  14. Avanzini F, Corsetti A, Maglione T, Alli C, Colombo F, Torri V, et al. Simple, shared guidelines raise the quality of antihypertensive treatment in routine care. Am Heart J 2002; 144:726–732

    Google Scholar 

  15. De Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA. Guide to Good Prescribing. WHO/Action programme on essential drugs, Geneva, 1994 WHO/DAP/94.11

  16. Karaalp A, Akici A, Kocabasoglu YE, Oktay S. What do the graduates think about the two-week rational pharmacotherapy course at the 5th year of their medical education? Med Teach 2003; 25(5):515–521

    Article  PubMed  CAS  Google Scholar 

  17. Akici A, Kalaca S, Gören MZ, Akkan AG, Karaalp A, Demir D, et al. Comparison rational pharmacotherapy decision making competence of general practitioners with intern doctors. Eur J Clin Pharmacol 2004; 60(2):75–82

    Google Scholar 

  18. Akici A, Kalaca S, Ugurlu MU, Karaalp A, Cali S, Oktay S. Impact of a short postgraduate course in rational pharmacotherapy for general practitioners. Br J Clin Pharmacol 2004; 57(3):310–321

    Google Scholar 

  19. Akici A, Kalaca S, Uğurlu MU, Oktay Ş. Prescribing habits of general practitioners in the treatment of childhood respiratory tract infections. Eur J Clin Pharmacol 2004; 60(3):211–216

    Article  PubMed  Google Scholar 

  20. Republic of Turkey, Ministry of Health. Diagnose and Treatment Guideline for Primary Health Care 2002 ISBN:975-590-058-6

  21. WHO/DAP/93.1 How to investigate drug use health facilities: selected drug use indicators. Geneva, 1993

  22. Kayaalp SO. BNF/TİK (British National Formulary/Turkish National Formulary- 2001). Turgut Yayıncılık ve Tic AŞ, Istanbul, Turkey. 2001 ISBN 975-7958-22-0

  23. The International Classification of Diseases, 9th Revision, Clinical Modification” (ICD-9-CM), Sixth Edition, issued for use beginning October 1, 2003 for federal fiscal year 2004 (FY04)

  24. Staessen JA, Wang J, Bianchi G, Birkenhager WH. Essential hypertension. Lancet 2003; 361:1629–1641

    Article  PubMed  Google Scholar 

  25. Moser M. Why are physicians not prescribing diuretics more frequently in the management of hypertension? JAMA 1998; 279:1813–1816

    Article  PubMed  CAS  Google Scholar 

  26. Standridge JB. A family physician questions the conclusions from ALLHAT. Am J Hypertens 2004; 17:361–365

    Article  PubMed  Google Scholar 

  27. Basile JN. Optimizing antihypertensive treatment in clinical practice. Am J Hypertens 2003; 16:13S–17S

    Article  PubMed  CAS  Google Scholar 

  28. Messerli FH, Grossman E, Goldbourt U. Are Beta blockers efficacious as first-line therapy for hypertension in the elderly? JAMA 1998; 279:1903–1907

    Article  PubMed  CAS  Google Scholar 

  29. De Salvia MA, Macchiarulo C, Lerro G, Pievi R, Renna G, Siro-Brigiani G, et al. Prescribing patterns for angiotensin-II receptor blockers in an Italian antihypertensive division: a retrospective chart review. Curr Ther Res Clin Exp 2002; 63:789–802

    Article  Google Scholar 

  30. Mazzeo F, Motola G, Rossi S, Russo F, Vitelli MR, Capuano A, et al. Management of hypertension by general practitioners : an Italian observational study. Adv Ther 2001; 18(3):122–130

    Google Scholar 

  31. Siegel D, Lopez J, Meier J, Goldstein MK, Lee S, Brazill BJ, et al. Academic detailing to␣improve antihypertensive prescribing patterns. Am J Hypertens 2003; 16:508–511

    Google Scholar 

  32. Ruoff GA. The impact of nonsteroidal anti-inflammatory drugs on hypertension: alternative analgesics for patients at risk. Clin Ther 1998; 20(3):376–387

    Article  PubMed  CAS  Google Scholar 

  33. Grossman E, Messerli FH. Are calcium antagonists beneficial in diabetic patients with hypertension? Am J Med 2004; 116:44–49

    Article  PubMed  CAS  Google Scholar 

  34. Parving HH. Is antihypertensive treatment the same for NIDDM and IDDM patients? Diabetes Res Clin Pract 1998; 39(Suppl):S43–S47

    Google Scholar 

  35. Pahor M, Psaty BM, Alderman MH, Applegate WB, Williamson JD, Cavazzini C, et al. Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomized controlled trials. Lancet 2000; 356: 1949–1954

    Google Scholar 

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Acknowledgements

This study was supported by Marmara University School of Medicine, Department of Pharmacology and Clinical Pharmacology.

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Authors and Affiliations

  1. Department of Pharmacology and Clinical Pharmacology, Marmara University School of Medicine, Haydarpaşa, Istanbul, 34668, Turkey

    Ahmet Akici & Ümit Uğurlu

  2. Department of Public Health, Marmara University School of Medicine, Haydarpaşa, Istanbul, 34668, Turkey

    Sibel Kalaça

  3. Department of Pharmacology, Marmara University, School of Pharmacy, Haydarpaşa, Istanbul, 34668, Turkey

    Hale Z. Toklu

  4. Omega-CRO, Tophanelioğlu Cad.,, Petek Sitesi A5 Blok, D.9, Altunizade, 34718, İstanbul, Turkey

    Şule Oktay

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  1. Ahmet Akici
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  2. Sibel Kalaça
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  3. Ümit Uğurlu
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  4. Hale Z. Toklu
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  5. Şule Oktay
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Correspondence to Şule Oktay.

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Akici, A., Kalaça, S., Uğurlu, Ü. et al. Antihypertensive drug utilization at health centres in a district of Istanbul. Pharm World Sci 29, 116–121 (2007). https://doi.org/10.1007/s11096-007-9103-5

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  • DOI: https://doi.org/10.1007/s11096-007-9103-5

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