Hospital Pharmacy - April 2018 - 110
110
Hospital Pharmacy 53(2)
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.
CCB.11 The international scenario also suggests a similar
prescription pattern. In a massive study conducted in China
during 2004-2007 and 2011-2015, CCB were the first choice
of drug followed by BB and ARB/ACEI, respectively.12,13 In
contrast, CCB were found to be least prescribed in a study
conducted in northern India,14 Bangladesh,15 and Mexico,16
whereas ARB, ARB, and ACEI were most preferred in these
areas, respectively. Studies from Nigeria17and Istanbul18
have shown maximum use of ACEI.
Although JNC 7 recommended 5 classes to be considered
as initial therapy but recommended thiazide-type diuretics
as initial therapy for most patients, it was observed that thiazide-type diuretics were rarely prescribed in most of the
studies.7,9,14 A similar report was demonstrated by a study
conducted in Taiwan by Liu and Wang.19 This category of
drugs does not seem to be the preference of the clinicians,
although these are the most cost-effective drugs available.20
There are studies which reported compliance with usage of
diuretics such as the data from National Health and Nutrition
Examination Survey during 1999-200221 and 2001-201022
belonging to Caucasian population. Even the Brazilian23
witnessed usage of diuretics. After updating JNC 7, there
were very few studies which have reported antihypertensive
drug utilization studies. A north Indian study24 showed
higher usage of diuretics (51%) in concordance with a
study conducted in Nigeria (64%)25 and Ethiopia (African
population),26 whereas diuretics were the last choice of drug
in a south Indian study (3.1%).27 It is interesting to note that
in the JNC 8 guidelines, BB were not part of the first line
therapy, and the same has reflected in our drug utilization
study. A study, ASCOT-BPLA (Anglo-Scandinavian Cardiac
Outcomes Trial-Blood Pressure Lowering Arm), showed
that BB were associated with greater risk of coronary events
and greater risk of stroke when compared with an amlodipine-based regimen.28 In another study conducted in geriatric
population, BB monotherapy was not only ineffective, but
when combined with diuretics, the benefits of the therapeutic outcome distinctly diminished.29 These reasons may
have contributed to removal of BB from the first line therapy in JNC 8. But if you look at the 2012 prescription pattern, BB were highly preferred choice of drug. This clearly
indicates that the JNC 8 guidelines were adopted quickly by
the clinicians, while the scenario might have not changed to
a great extent in other clinical setups. The variations in different prescribing patterns across the world may be attributed to the genetic makeup of the populations. The
therapeutic outcome is based on the gene pool of the multiple ethnicities30; therefore, we observe the different recommendations in black and nonblack populations.3 Large
studies are necessary to identify the drugs that are more
Table of Contents for the Digital Edition of Hospital Pharmacy - April 2018
Ed Board
TOC
HPX
Why Is Burnout a Taboo?
Stability of 2 mg/mL Adenosine Solution in Polyvinyl Chloride and Polyolefin Infusion Bags
Glecaprevir/Pibrentasvir
New Medications in the Treatement of Acute Decompensated Heart Failure
The Prescription Drug User Fee Act: Cause for Concern?
ISMP Medication Error Report Analysis
ISMP Adverse Drug Reactions
Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital
Breadth of Statistical Training Among Pharmacy Residency Programs Across the United States
Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study
Changes in Pharmacy Residency Training Design Between 2012 and 2017: A Perspective of Academic Medical Centers
Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement
Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy
Hospital Pharmacy - April 2018 - Cover1
Hospital Pharmacy - April 2018 - Cover2
Hospital Pharmacy - April 2018 - Ed Board
Hospital Pharmacy - April 2018 - TOC
Hospital Pharmacy - April 2018 - HPX
Hospital Pharmacy - April 2018 - Why Is Burnout a Taboo?
Hospital Pharmacy - April 2018 - Stability of 2 mg/mL Adenosine Solution in Polyvinyl Chloride and Polyolefin Infusion Bags
Hospital Pharmacy - April 2018 - 74
Hospital Pharmacy - April 2018 - Glecaprevir/Pibrentasvir
Hospital Pharmacy - April 2018 - 76
Hospital Pharmacy - April 2018 - 77
Hospital Pharmacy - April 2018 - 78
Hospital Pharmacy - April 2018 - 79
Hospital Pharmacy - April 2018 - 80
Hospital Pharmacy - April 2018 - 81
Hospital Pharmacy - April 2018 - 82
Hospital Pharmacy - April 2018 - 83
Hospital Pharmacy - April 2018 - 84
Hospital Pharmacy - April 2018 - New Medications in the Treatement of Acute Decompensated Heart Failure
Hospital Pharmacy - April 2018 - 86
Hospital Pharmacy - April 2018 - 87
Hospital Pharmacy - April 2018 - The Prescription Drug User Fee Act: Cause for Concern?
Hospital Pharmacy - April 2018 - 89
Hospital Pharmacy - April 2018 - ISMP Medication Error Report Analysis
Hospital Pharmacy - April 2018 - 91
Hospital Pharmacy - April 2018 - 92
Hospital Pharmacy - April 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - April 2018 - 94
Hospital Pharmacy - April 2018 - 95
Hospital Pharmacy - April 2018 - Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital
Hospital Pharmacy - April 2018 - 97
Hospital Pharmacy - April 2018 - 98
Hospital Pharmacy - April 2018 - 99
Hospital Pharmacy - April 2018 - 100
Hospital Pharmacy - April 2018 - Breadth of Statistical Training Among Pharmacy Residency Programs Across the United States
Hospital Pharmacy - April 2018 - 102
Hospital Pharmacy - April 2018 - 103
Hospital Pharmacy - April 2018 - 104
Hospital Pharmacy - April 2018 - 105
Hospital Pharmacy - April 2018 - 106
Hospital Pharmacy - April 2018 - Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study
Hospital Pharmacy - April 2018 - 108
Hospital Pharmacy - April 2018 - 109
Hospital Pharmacy - April 2018 - 110
Hospital Pharmacy - April 2018 - 111
Hospital Pharmacy - April 2018 - 112
Hospital Pharmacy - April 2018 - Changes in Pharmacy Residency Training Design Between 2012 and 2017: A Perspective of Academic Medical Centers
Hospital Pharmacy - April 2018 - 114
Hospital Pharmacy - April 2018 - 115
Hospital Pharmacy - April 2018 - 116
Hospital Pharmacy - April 2018 - 117
Hospital Pharmacy - April 2018 - 118
Hospital Pharmacy - April 2018 - 119
Hospital Pharmacy - April 2018 - 120
Hospital Pharmacy - April 2018 - Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement
Hospital Pharmacy - April 2018 - 122
Hospital Pharmacy - April 2018 - 123
Hospital Pharmacy - April 2018 - 124
Hospital Pharmacy - April 2018 - Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy
Hospital Pharmacy - April 2018 - 126
Hospital Pharmacy - April 2018 - 127
Hospital Pharmacy - April 2018 - 128
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