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diabetes or nondiabetic chronic kidney disease and also for the
general hypertensive population younger than 60 years. In connection to this, we conducted a cross-sectional retrospective
study in 2 calendar years, namely, 2012 and 2014, to determine
rational drug prescription of antihypertensive drugs and to note
whether the physicians have adopted the new guidelines.

Materials and Methods
The study was initiated after obtaining approval from
Institutional Ethics Committee at National Institute of
Nutrition (NIN protocol number: 02/2011/IV bearing ERC
No. ECR/351/Inst/AP/2013) and the study center which is
Gandhi Hospital (Rc. No. IEC/GMC/2012/dt 18/6 bearing
ERC No. ECR/180/Inst/AP/2013).
Following World Health Organization (WHO) guidelines, a schedule for monitoring the prescription profile of
antihypertensive drugs was indigenized, pretested, and
standardized. The study was carried out in the outpatient
block in the Department of General Medicine at Gandhi
Hospital during June to December 2012 and July to
December 2014. Therefore, the prescription profiles were
studied in 2 calendar years, namely, 2012 and 2014. The
information was collected from the prescriptions of the
patients after consulting the physician, with an age more
than 25 years, of either gender who were chronic or de
novo hypertensive and agreed to provide the information
requested. The standardized schedule encompasses information regarding the sociodemographic details, antihypertensive drugs prescribed, number of comorbidities, and
total number of drugs prescribed. The prescription was
also analyzed for the usage of generic names. The compliance to National List of Essential Medicines (NLEM) 2011
was also evaluated.4 Antihypertensive therapy could be
monotherapy or polytherapy where a single active ingredient is used or may have single pill or multiple combinations of active antihypertensive ingredients, respectively.
Descriptive statistics were used to understand the basic
characteristics of the study. The prescription profile of antihypertensive therapy was measured in the years 2012 and
2014 using the chi-square test of heterogeneity. The data
were also compared to see whether any differences existed
between previous and current therapy as the data were collected in a retrospective fashion. The variables captured were
age groups, gender, age of hypertension, classes of drugs, use
of generic drug names or trade names, type of therapy,
NLEM antihypertensive drugs, comorbidity, total number of
drugs in the prescription, and calendar year. The Statistical
Package for Social Sciences (SPSS) version 16.0 was used
for all statistical analyses. All P values <.05 were regarded as
statistically significant.

Results
A total of 652 hypertensive individuals were initially
screened. Of these, 58 patients who were treated with other

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classes of antihypertensive agents (α-blockers, vasodilators,
and other classes of antihypertensive) due to their fewer
numbers were not included for the purpose of study along
with 44 patients who were uncooperative and noncompliant.
We were left with 550 prescriptions, which were considered
for the prescription study.
Majority of the population belonged to less than 50 years
of age in both the calendar years (Table 1). The number of
males with hypertension attending the outpatient block was
higher in the year 2014 (n = 217, 79.2%) than in the year
2012 (n = 159, 57.6%).
The age of hypertension is defined as the time period from
the date of first diagnosis of hypertension till the date of collection of data. It is critical to note that a great proportion of
patients were in the less than 1 year group (90.1%) of age of
hypertension in the year 2014, indicating more number
of people were recently diagnosed with hypertension and are
drug naive, whereas 46% belonged to the 1- to 5-year group
during the year 2012. The 2012 prescriptions were more
compliant with the usage of generic names: previous generic
names (24% vs 11.4%, P < .001) and current use of generic
names (28.3% vs 11.3%, P < .001). Similar was the case with
NLEM compliance (previous therapy: 79.6% and 61.8%;
current therapy: 79.3% and 60.9%, respectively). It was
noticed that the majority of study population had only essential hypertension (year 2012: 71% and year 2014: 97.1%,
P < .001), and few comprised of other comorbidities.
Most importantly, monotherapy was highly preferred in
previous (79% vs 52.1%) as well as in the current therapy
(82.5% vs 56.9%, P < .001) of 2014 prescriptions. It was
alarming to have seen as meager as 0.7% in 2012 and 0% in
2014 prescriptions contained thiazide diuretics in the current
therapy (Figure 1). Among all antihypertensive drug visits,
in the year 2012, BB (previous therapy: 24.1% and current
therapy: 21.7%, P < .001) were majorly prescribed, while it
is striking to notice that BB were least prescribed monotherapy after thiazide diuretics in the year 2014 (Supplementary
Table 1). Moreover, ACEI (24.5%) were the first choice of
drug during 2014 in the current therapy, whereas CCB was
prescribed 23.5% in previous therapy. It is interesting to note
that the third choice of drug prescribed during 2012 after
CCB (previous therapy: 15.3% and current therapy: 17.4%,
P < .001) was combination of CCB and BB (previous therapy: 14.8% and current therapy: 13.4%, P < .001). Among
the combination therapy, CCB were the most commonly
combined drug with other antihypertensive drugs (22.4% in
2012 and 13.1% in 2014, P < .001).

Discussion
Our study recorded the use of antihypertensive drugs in the
order of BB > CCB > CCB + BB > ARB > ACEI in the year
2012, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB. In concordance
with our 2012 prescriptions, cardiologists of Iran also preferred the use of BB followed by CCB.5 Although our study

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