Advertisement

Pharmacy World & Science

, Volume 29, Issue 3, pp 116–121 | Cite as

Antihypertensive drug utilization at health centres in a district of Istanbul

  • Ahmet Akici
  • Sibel Kalaça
  • Ümit Uğurlu
  • Hale Z. Toklu
  • Şule OktayEmail author
Article

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.

Key words

Hypertension Prescription Rational pharmacotherapy General practitioner Turkey Antihypertensives 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Acknowledgements

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

References

  1. 1.
    Guidelines Subcommittee World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. J Hypertens 1999; 17:151–183Google Scholar
  2. 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; 157:2413–2446CrossRefGoogle Scholar
  3. 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; 63:295–303PubMedCrossRefGoogle Scholar
  4. 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): 136–141PubMedCrossRefGoogle Scholar
  5. 5.
    Altan Onat, editor. Heart Health, Risk Profile and Heart Disease among Turkish Adults. TEKHARF Study. August 2000, Istanbul. ISBN: 975-596-016-3Google Scholar
  6. 6.
    Giles TD. Pharmacoeconomic issues in antihypertensive therapy. Am J Cardiol 1999; 84:25K–28KPubMedCrossRefGoogle Scholar
  7. 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; 11:487–493PubMedCrossRefGoogle Scholar
  8. 8.
    Rizzo JA, Simons WR. Variations in compliance among hypertensive patients by drug class: implications for health care costs. Clin Ther 1997; 19(6):1446–1457PubMedCrossRefGoogle Scholar
  9. 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; 28:760–766Google Scholar
  10. 10.
    Faulhaber HD, Luft FC. Treatment of high blood pressure in Germany. Am J Hypertens 1998; 11:750–753PubMedCrossRefGoogle Scholar
  11. 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):407–414PubMedCrossRefGoogle Scholar
  12. 12.
    Pardell H, Tresserras R, Armario P, Hernandez R. Actions implemented to improve hypertension control in Spain. Am J Hypertens 1998; 11:763–765PubMedCrossRefGoogle Scholar
  13. 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):695–703PubMedCrossRefGoogle Scholar
  14. 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; 144:726–732Google Scholar
  15. 15.
    De Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA. Guide to Good Prescribing. WHO/Action programme on essential drugs, Geneva, 1994 WHO/DAP/94.11Google Scholar
  16. 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):515–521PubMedCrossRefGoogle Scholar
  17. 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):75–82Google Scholar
  18. 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):310–321Google Scholar
  19. 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):211–216PubMedCrossRefGoogle Scholar
  20. 20.
    Republic of Turkey, Ministry of Health. Diagnose and Treatment Guideline for Primary Health Care 2002 ISBN:975-590-058-6Google Scholar
  21. 21.
    WHO/DAP/93.1 How to investigate drug use health facilities: selected drug use indicators. Geneva, 1993Google Scholar
  22. 22.
    Kayaalp SO. BNF/TİK (British National Formulary/Turkish National Formulary- 2001). Turgut Yayıncılık ve Tic AŞ, Istanbul, Turkey. 2001 ISBN 975-7958-22-0Google Scholar
  23. 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)Google Scholar
  24. 24.
    Staessen JA, Wang J, Bianchi G, Birkenhager WH. Essential hypertension. Lancet 2003; 361:1629–1641PubMedCrossRefGoogle Scholar
  25. 25.
    Moser M. Why are physicians not prescribing diuretics more frequently in the management of hypertension? JAMA 1998; 279:1813–1816PubMedCrossRefGoogle Scholar
  26. 26.
    Standridge JB. A family physician questions the conclusions from ALLHAT. Am J Hypertens 2004; 17:361–365PubMedCrossRefGoogle Scholar
  27. 27.
    Basile JN. Optimizing antihypertensive treatment in clinical practice. Am J Hypertens 2003; 16:13S–17SPubMedCrossRefGoogle Scholar
  28. 28.
    Messerli FH, Grossman E, Goldbourt U. Are Beta blockers efficacious as first-line therapy for hypertension in the elderly? JAMA 1998; 279:1903–1907PubMedCrossRefGoogle Scholar
  29. 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; 63:789–802CrossRefGoogle Scholar
  30. 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):122–130Google Scholar
  31. 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; 16:508–511Google Scholar
  32. 32.
    Ruoff GA. The impact of nonsteroidal anti-inflammatory drugs on hypertension: alternative analgesics for patients at risk. Clin Ther 1998; 20(3):376–387PubMedCrossRefGoogle Scholar
  33. 33.
    Grossman E, Messerli FH. Are calcium antagonists beneficial in diabetic patients with hypertension? Am J Med 2004; 116:44–49PubMedCrossRefGoogle Scholar
  34. 34.
    Parving HH. Is antihypertensive treatment the same for NIDDM and IDDM patients? Diabetes Res Clin Pract 1998; 39(Suppl):S43–S47Google Scholar
  35. 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: 1949–1954Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ahmet Akici
    • 1
  • Sibel Kalaça
    • 2
  • Ümit Uğurlu
    • 1
  • Hale Z. Toklu
    • 3
  • Şule Oktay
    • 4
    Email author
  1. 1.Department of Pharmacology and Clinical PharmacologyMarmara University School of MedicineHaydarpaşa, IstanbulTurkey
  2. 2.Department of Public HealthMarmara University School of MedicineHaydarpaşa, IstanbulTurkey
  3. 3.Department of PharmacologyMarmara University, School of PharmacyHaydarpaşa, IstanbulTurkey
  4. 4.Omega-CRO, Tophanelioğlu Cad.,İstanbulTurkey

Personalised recommendations