A Multi-Centric Study of Real-World Prescription Pattern of More Than Three Drugs for the Control of Hypertension Among Cardiologists

Abstract Resistant Hypertension is blood pressure control requiring more than three drugs – commonly a thiazide like diuretic, calcium channel blocker (CCB), and RAAS inhibitor. But, in clinical practice, several patients take more than three drugs for hypertension (HTN) control that may not contain all these three drugs. There is no dedicated real-world large-scale study in this segment. A prospective multicentric cross-sectional observational study among Cardiologists on the prescription pattern in adults (aged ≥ 18 years) on more than three drugs for the control of (HTN) was undertaken. The drugs could be from any class of the antihypertensive medication. Persons with renal denervation, renal transplant and known renal artery stenosis were excluded. From 10 centers, 420 patients were studied. The mean age was 65.2 years (M: F ratio 1: 0.8). RAASi, CCB and diuretic use were 89%, 85%, and 82% respectively. Betablocker (BB) use was very high at 85%. The use of MRAs was only 39% while this was the recommended fourth drug. Even among patients who qualify for the diagnosis of resistant HTN on CCB, RAASi, and thiazide like diuretic (n=273), when the serum Potassium was ≤ 4.5 mEq/L, the MRA use was only 38%. This is the largest real-world multicenter observational study and has shown that the prescription pattern of more than three drugs for the control of HTN among cardiologists shows an overwhelming use of BB (85%) and gross underutilization of MRAs (39%) – highlighting the scope for improvement in the prescription pattern during polypharmacy of HTN.