Skip to main content

Advertisement

SpringerLink
Log in

Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To determine the impact of drug prescribing pattern, outpatient drug price of medicines, and level of adherence to evidence-based international guidelines on blood pressure (BP) control at selected hospitals in Southern Ethiopia.

Methods

Hospital-based cross-sectional study was conducted. The data entry and analysis were done by using SPSS version 21.0.

Results

A mean age of participants was 55.87 ± 11.02 years. The rate of BP control was 17.5% based on International Society of Hypertension (ISH) guidelines 2020. In about two-thirds of patients, 270 (66.5%) were taking combination therapy. Mean annual cost of drugs for hypertension was 11.39 ± 3.98 US dollar (USD). Treatment was affordable for only 91 (22.4%) of patients. There was considerable variation on prescriber’s adherence to evidence-based guidelines. Body mass index (BMI) of 18–24.9 kg/m2, adjusted odds ratio (AOR) = 3.63 (95% confidence interval (C.I), 1.169–11.251, p = 0.026), physically activity, AOR = 12.69 (95% C.I, 1.424–113.17, p = 0.023), presence of no comorbidity, AOR = 12.82 (95% C.I, 4.128–39.816, p = 0.000), and taking affordable antihypertensive regimen, AOR = 3.493 (95% C.I, 1.4242–9.826, p = 0.018), were positively associated BP control.

Conclusion

The level of BP control, affordability of drugs for the management of hypertension and related comorbidities, and the prescriber’s adherence to evidence-based guidelines were inadequate. Therefore, addressing factors associated with good BP control including affordability and clinician adherence to evidence-based guidelines by responsible stakeholders could improve BP control and reduce associated complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

All the data reported in the manuscript are publicly available upon acceptance of the manuscript.

References

  1. Collaborators GRF (2018) Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1923–94

  2. Cappuccio FP, Miller MA (2016) Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and interventions. Intern Emerg Med 11(3):299–305

    Article  Google Scholar 

  3. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al (2020) 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 75(00):1–25

    Google Scholar 

  4. Geldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, Tsabedze L, Supiyev A, Sturua L, Bahendeka SK, Sibai AM (2019) The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet 6736(19):30955–9

  5. Institute EPH (2016) Ethiopia steps report on risk factors for chronic non-communicable diseases and prevalence of selected NCDs

  6. Gerba H, Yegezu Y, Ejigu E, Giorgis A (2017) Pharmaceutical sector assessment in Ethiopia: food medicine and health care administration and control authority. 1–64

  7. Sorato MM, Davari M, Kebriaeezadeh A (2019) Health care system response to cardiovascular diseases, trends from 2010–2018: can Ethiopia achieve 2025 global voluntary targets for non-communicable diseases from cardiovascular diseases perspective? Explanatory review of available literatures. Research & Reviews: J Med Health Sci 9(1):1–13

  8. Health FDRoEMo (2015) Health sector transformation plan (2015/16–2019/20). Ministry of Health Addis Ababa

  9. Health FDRoEMo (2010) Health sector development program IV, 2010/11—2014/15. Ministry of Health Addis Ababa; 2010.

  10. Agency TfdroEcs (2018) The 2015/16 Ethiopian household consumption expenditure (HCE) survey results for country level statistical report January 2018 Addis Ababa. Stat Bulletin 585:1-272

  11. Shiferaw F, Letebo M, Misganaw A, Feleke Y, Gelibo T, Getachew T et al (2018) Non-communicable diseases in Ethiopia: disease burden, gaps in health care delivery and strategic directions. Ethiop J Health Dev 32(3)

  12. Elzinga G, Jerene D, Mesfin G, Negussie S (2010) Human resources for health implications of scaling up for universal access to HIV/AIDS prevention, treatment, and care: Ethiopia rapid situational analysis. Group GHWATW, editor Addis Ababa, Ethiopia

  13. Getachew T, Bekele A, Amenu K, Defar A, Teklie H, Taye G et al (2017) Service availability and readiness for major non-communicable diseases at health facilities in Ethiopia. Ethiopian Journal of Health Development 31(1):384–390

    Google Scholar 

  14. Whelton PK CR, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension (Dallas, Tex : 1979) 71:e13-e115

  15. Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS et al (2019) Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 393(10184):1958–1972

    Article  Google Scholar 

  16. Yazdanshenas H, Bazargan M, Orum G, Loni L, Mahabadi N, Husaini B (2014) Prescribing patterns in the treatment of hypertension among underserved African American elderly. Ethn Dis 24(4):431–437

    PubMed  Google Scholar 

  17. Adler AJ, Prabhakaran D, Bovet P, Kazi DS, Mancia G, Mungal-Singh V, Poulter N (2015) Reducing cardiovascular mortality through prevention and management of raised blood pressure. A world heart federation road map. Global Heart 10(2):111–22

  18. Arshad V, Samad Z, Das J, Almas A, Rashid N, Virani SS et al (2020) Prescribing patterns of antihypertensive medications in low- and middle-income countries: a systematic review. Asia Pacific Journal of Public Health 33(1):14–22

    Article  Google Scholar 

  19. World Health Organization (2003) Introduction to drug utilization research: World Health Organization

  20. Shalini S, Ravichandran V, Mohanty B, Dhanaraj S, Saraswathi R (2010) Drug utilization studies-an overview. Inter J Pharmaceut Sci Nanotechnol 31:803–810

    Google Scholar 

  21. Norheim OF, Baltussen R, Johri M, Chisholm D, Nord E, Brock D et al (2014) Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc 12:18

  22. World Health Organization (2019) It’s time to walk the talk: WHO independent high-level commission on noncommunicable diseases final report. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO

  23. Ruhil R (2018) The changing wealth of nations 2018. Building a sustainable future. By Glenn-Marie Lange, Quentin Wodon and Kevin Carey; Washington DC: World Bank Group.© World Bank. IASSI-Quarterly 37(1):135–7

  24. World Health Organization (2009) WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2010. Oslo [cited 2010 Sep 10]

  25. Xu H, He Y, Xu L, Yan X, Dai H (2015) Trends and patterns of five antihypertensive drug classes between 2007 and 2012 in China using hospital prescription data. Int J Clin Pharmacol Ther 53(6):430–437

    Article  Google Scholar 

  26. Statistics ABo (2013) Australian health survey: health service usage and health related actions, 2011–12. ABS Canberra

  27. Health AIo, Welfare (2017) Medicines for cardiovascular disease. Canberra: AIHW

  28. Jarari N, Rao N, Peela JR, Ellafi KA, Shakila S, Said AR et al (2016) A review on prescribing patterns of antihypertensive drugs. Clinical Hypertension 22(1):7

    Article  Google Scholar 

  29. Beaglehole R, Bonita R, Ezzati M, Alleyne G, Dain K, Kishore SP et al (2014) NCD Countdown 2025: accountability for the 25× 25 NCD mortality reduction target. The Lancet 384(9938):105–107

    Article  Google Scholar 

  30. Price AJ, Crampin AC, Amberbir A, Kayuni-Chihana N, Musicha C, Tafatatha T et al (2018) Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi. Lancet Diabetes Endocrinol 6(3):208–222

    Article  Google Scholar 

  31. Goverwa TP, Masuka N, Tshimanga M, Gombe NT, Takundwa L, Bangure D et al (2014) Uncontrolled hypertension among hypertensive patients on treatment in Lupane District, Zimbabwe, 2012. BMC Res Notes 7(1):703

    Article  Google Scholar 

  32. Muleta S, Melaku T, Chelkeba L, Assefa D (2017) Blood pressure control and its determinants among diabetes mellitus comorbid hypertensive patients at Jimma University Medical Center, South West Ethiopia. . Clin Hypertension 3(29)

  33. Gebremichael GB, Berhe KK, Zemichael TM (2019) Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC Cardiovascular Disorders 19(121)

  34. Yazie DSW, Alebachew M, Berha AB (2018) Assessment of blood pressure control among hypertensive patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a cross-sectional study. J Bioanal Biomed 10:80–87

    Article  Google Scholar 

  35. Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PGM (2017) Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open 7(8):e015743

    Article  Google Scholar 

  36. Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R et al (2016) Community perceptions of community health workers (CHWs) and their roles in management for HIV, tuberculosis and hypertension in Western Kenya. PLoS ONE 11(2):e0149412

    Article  Google Scholar 

  37. Woldegebriel AS, Gudina EK, Alemu DT (2016) Assessment of blood pressurecontrol among hypertensive patients in Southwest Ethiopia. PLoS ONE 11(11)

  38. Muleta S, Melaku T, Chelkeba L, Assefa D (2017) Blood pressure control and its determinants among diabetes mellitus co-morbid hypertensive patients at Jimma University Medical Center. South West Ethiopia Clin Hypertens 23:29

    Article  Google Scholar 

  39. World Health Organization (2013) Global action plan for the prevention and control of non-communicable diseases 2013–2020

  40. Teshome DFDA, Zeleke BM (2018) Determinants of blood pressure control amongst hypertensive patients in Northwest Ethiopia. PLoS ONE 13(5)

  41. World Health Organization (2016) Final report of the Commission on Ending Childhood Obesity

  42. Gareth Beevers GYHL, Eoin O'Brien (2014) ABC of hypertension. Sixth edition ed. Series A, editor

  43. Arnett DKBR, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B (2019) ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 140:e563–e595

    PubMed  PubMed Central  Google Scholar 

  44. Shrestha PL, Shrestha PA, Vivo RP (2016) Epidemiology of comorbidities in patients with hypertension. Curr Opin Cardiol 31(4):376–380

    Article  Google Scholar 

  45. Noh J, Kim HC, Shin A, Yeom H, Jang S-Y, Lee JH et al (2016) Prevalence of comorbidity among people with hypertension: the Korea National Health and Nutrition Examination Survey 2007–2013. kcj 46(5):672–80

  46. Noh J, Kim HC, Shin A, Yeom H, Jang S-Y, Lee JH et al (2016) Prevalence of comorbidity among people with hypertension: the Korea National Health and Nutrition Examination Survey 2007–2013. Korean Circ J 46(5):672–680

    Article  Google Scholar 

  47. Wang J, Ma JJ, Liu J, Zeng DD, Song C, Cao Z (2017) Prevalence and risk factors of comorbidities among hypertensive patients in China. Int J Med Sci 14(3):201

    Article  CAS  Google Scholar 

  48. Shukrala F, Gabriel T (2015) Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar. Eastern Ethiopia Drug Des Devel Ther 9:519–523

    CAS  PubMed  Google Scholar 

  49. Kim SH, Shin DW, Kim S, Han K, Park S-h, Kim Y-H et al (2019) Prescribing patterns of antihypertensives for treatment-naïve patients in South Korea: from Korean NHISS claim data. Int J Hypertension 2019.

  50. Busser D, Yarlagadda R, Ahmed SM (2016) Assessment of antihypertensive drugs utilization pattern in Butajira Zonal Hospital, Butajira Town, South Ethiopia. Int J Pharm Sci Res 7(10):4028

    CAS  Google Scholar 

  51. Fufa F, Mirkano D, Tipathi R (2015) Prescription pattern and potential drug-drug interactions of antihypertensive drugs in a general hospital, South Ethiopia. Cukurova Med J 40:698–706

  52. Abegaz TM, Tefera YG, Abebe TB (2017) Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study. Integr Pharm Res Pract 6:29–35

    Article  Google Scholar 

  53. Eslampanah Z (2016) Drug utilization evaluation of anti-hypertensive agents in a medical care hospital. Int J Pharm Sci Res 7(2):862

    CAS  Google Scholar 

  54. Catić T, Begović B (2011) Outpatient antihypertensive drug utilization in Canton Sarajevo during five years period (2004–2008) and adherence to treatment guidelines assessment. Bosn J Basic Med Sci 11(2):97–102

    Article  Google Scholar 

  55. Ishida T, Oh A, Hiroi S, Shimasaki Y, Tsuchihashi T (2019) Current prescription status of antihypertensive drugs in Japanese patients with hypertension: analysis by type of comorbidities. Clin Exp Hypertens 41(3):203–210

    Article  Google Scholar 

  56. Ahmed A, Saqlain M, Tanveer M, Nawaz MS, Rehman K, Safdar A et al (2021) Prescribing patterns of antihypertensive drugs in patients attending tertiary care hospitals in Pakistan. SN Comprehensive Clinical Medicine 3(1):176–182

    Article  CAS  Google Scholar 

  57. Ng J-M, Kua KP, Lee SWH (2020) Prescribing patterns of antihypertensive medications and blood pressure control among hypertensive patients in a primary care setting in Malaysia. Prog Drug Discov Biomed Sci 3(1)

  58. Paradkar SG, Sinha SR (2018) Drug utilization among hypertensive patients in the outpatient department of medicine in a tertiary care hospital: a cross-sectional study. Clin Exp Hypertens 40(2):150–154

    Article  Google Scholar 

  59. Grimmsmann T, Himmel W (2011) Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes? Eur J Clin Pharmacol 67(8):847–854

    Article  CAS  Google Scholar 

  60. Attaei MW, Khatib R, McKee M, Lear S, Dagenais G, Igumbor EU et al (2017) Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data. The Lancet Public Health 2(9):e411–e419

    Article  Google Scholar 

  61. Rachana P, Anuradha H (2014) Anti hypertensive prescribing patterns and cost analysis for primary hypertension: a retrospective study. Journal of clinical and diagnostic research: JCDR 8(9):HC19

  62. Umegbolu EI (2017) Prescribing patterns in systemic hypertension and pharmaco-economics (cost effectiveness and cost minimisation analyses) of the commonly prescribed antihypertensives in a district hospital in Enugu State, Southeast Nigeria. 2017;6(1):7

  63. Mensa Sorato M, Davari M, Abdollahi Asl A, Soleymani F, Kebriaeezadeh A (2020) Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective. J Pharm Health Serv Res 11(4):321–333

    Article  Google Scholar 

  64. Sorato MM, Davari M, AbdollahiAsl A (2020) Descriptive evaluation of national and international hypertension treatment guidelines: the guideline quality and comprehensiveness to provide care to adult with hypertension. Clinical Medical Reviews and Case Reports 7(5):1–14

    Google Scholar 

  65. Pittrow D, Kirch W, Bramlage P, Lehnert H, Höfler M, Unger T et al (2004) Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol 60(2):135–142

    Article  CAS  Google Scholar 

  66. Elliott WJ (2008) What factors contribute to the inadequate control of elevated blood pressure? The Journal of Clinical Hypertension 10:20–26

    Article  Google Scholar 

  67. Hyman DJ, Pavlik VN, Greisinger AJ, Chan W, Bayona J, Mansyur C et al (2012) Effect of a physician uncertainty reduction intervention on blood pressure in uncontrolled hypertensives–a cluster randomized trial. J Gen Intern Med 27(4):413–419

    Article  Google Scholar 

  68. Neutel JM (2008) Prescribing patterns in hypertension: the emerging role of fixed-dose combinations for attaining BP goals in hypertensive patients. Curr Med Res Opin 24(8):2389–2401

    Article  CAS  Google Scholar 

  69. Fretheim A, Oxman AD (2005) International variation in prescribing antihypertensive drugs: Its extent and possible explanations. BMC Health Serv Res 5(1):21

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank all patients who participated in this study for their valuable dedication to providing information. We would also like to thank Arba Minch University College of Medicine and Health Sciences and Tehran University Medical Sciences, Department of Pharmacoeconomics and Pharmaceutical Administration staff for their technical and material support during this manuscript development.

Author information

Authors and Affiliations

  1. Tehran University of Medical Sciences, Tehran, Iran

    Mende Mensa Sorato

  2. College of Medicine and Health Sciences, Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia

    Mende Mensa Sorato

  3. Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran

    Majid Davari & Abbas Kebriaeezadeh

  4. Isfahan Cardiovascular Research Center, WHO Collaborating Center in EMR, Isfahan University of Medical Sciences, Isfahan, Iran

    Nizal Sarrafzadegan

  5. College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia

    Tamiru Shibru

Authors
  1. Mende Mensa Sorato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Majid Davari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abbas Kebriaeezadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nizal Sarrafzadegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tamiru Shibru
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors read and approved the manuscript. MM conceived the study, conducted the study, and developed the manuscript; MD participated in data analysis and reviewed the manuscript and AK reviewed the manuscript and write-up process; NS and TS participated in literature review and polished the language of the manuscript.

Corresponding author

Correspondence to Mende Mensa Sorato.

Ethics declarations

Ethics approval and consent to participate

The study was approved by Tehran University of Medical Sciences, Faculty of Pharmacy, Department of Pharmacoeconomics, and Pharmaceutical Administration ethical review board with approval ID: IR.TUMS.MEDICINE.REC.1399.674 and Arba Minch University College of Medicine and Health Sciences Institutional review board with reference number: IRB/T10/2012. After clarifying the study objective and confidentiality of the information, verbal informed consent was obtained from each respective hospital before data collection.

Consent for publication

All authors read the full version of this manuscript and agreed to publish.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sorato, M.M., Davari, M., Kebriaeezadeh, A. et al. Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia. Eur J Clin Pharmacol 78, 1487–1502 (2022). https://doi.org/10.1007/s00228-022-03352-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-022-03352-9

Keywords

Search

Navigation