What does this research mean for the field?

The treatment of uncomplicated hypertension among black patients in Nigeria is characterized by high levels of polypharmacy, non-generic prescribing, and medication doses that frequently exceed the standard Defined Daily Dose (DDD). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 13, 2019Open Access

Antihypertensive prescription among black patients without compelling indications: prescription, effectiveness, quality and cost of medication

Structured PICO

Population

1,050 black patients >30 years of age with uncomplicated hypertension (without compelling indications or comorbid conditions such as diabetes mellitus, renal diseases, congestive heart failure, or ischemia), mean age 59.9, 61.5% female, attending clinics at the University College Hospital in Ibadan, Nigeria.

Intervention

Antihypertensive medications (including diuretics, calcium channel blockers, ACE inhibitors, ARBs, beta-blockers, and centrally acting anti-adrenergic drugs) prescribed as monotherapy or combination therapy.

Outcome

Prescription patterns and quality (compared to Defined Daily Dose), blood pressure control (<140/90 mmHg), and cost of medication.surrogate

In Nigerian patients with uncomplicated hypertension, there is a high prevalence of polypharmacy, non-generic prescribing, and sub-optimal blood pressure control, highlighting the need for cost-effective fixed-dose combinations.

Abstract

BACKGROUND: Hypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications. METHOD: Patients with uncomplicated hypertension attending three clinics in the University College Hospital, Ibadan in Nigeria were recruited into this study. Information on demographics, antihypertensive medication prescribed, blood pressure measurements, and cost of medications were collected for each patient. Antihypertensive medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) system. The frequency of usage of each drug class and their prescribed doses per patient/day were calculated and compared with the DDD to assess the quality of prescription. Cost of antihypertensive medication was calculated for each patient and reported as cost per patient/day and cost per patient/month. Effect of variables on BP control was ascertained. Statistical analyses were done using SPSS, chi-square and correlation test was used to test for associations. RESULT: = 33. 618, p < 0. 001; r =. 18, p < 0. 001). The most prescribed antihypertensive medication either as a single therapy or a fixed-dose combination was diuretic. About 54% of the prescribed daily doses of antihypertensive medication exceeded the DDD. The total monthly expenditure on antihypertensive drugs was approximately N3. 2 million (15, 300). CONCLUSION: Study findings show a high level of polypharmacy and non-generic prescribing. Increased prescribing of drugs that are cost-effective, as well as prescription of fixed dose combinations (FDCs), is recommended in hypertensive patients. This is necessary to control blood pressure while increasing treatment adherence.

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