Key result
Antihypertensive drug switching occurs in ~39% of patients, linked to ~3.2-fold higher odds in 2014.
Why the study?
Factors associated with switching of antihypertensive drugs are well documented in developed nations but rarely reported in developing countries, especially in India.
Cross-Sectional (n=429)
No
Early switching signals need for tighter initial BP control; extends Western modification drivers to Indian cohorts but leaves open intervention effects.
OBJECTIVE: Switching of antihypertensive drugs is attributed to uncontrolled blood pressure (BP) which imposes a great burden on health economics. But again, switching leads to accomplishment of the goal BP, thereby improving the health status. Such studies are well documented in developed nations but rarely reported in developing countries, especially in India. Therefore, the aim of this study was to evaluate various factors associated with switching of antihypertensive drugs. METHODS: A cross-sectional retrospective investigation was performed using a standardized schedule adapting the World Health Organization indicators for drug utilization in a tertiary care government hospital, Hyderabad, India. A total of 429 prescriptions were monitored for a switchover to a different antihypertensive drug in 180 days. RESULTS: The results revealed that the duration of hypertension (HTN) >5–10 years (adjusted odds ratio [aOR] = 3.73, P < 0.05), two or more symptoms of HTN (aOR = 3.42, P < 0.05), 2014 prescriptions (aOR = 4.54, P < 0.001), polytherapy (aOR = 2.85, P < 0.001), noncompliance to National List of Essential Medicine (NLEM) (aOR = 1.631, P < 0.05), and systolic BP (SBP) (aOR = 1.77, P < 0.05) were the predictors, which were highly likely to switch (38.5%) the antihypertensive drugs. Diuretics (0.7%) were poorly prescribed, the first line of therapy suggested by Seventh Joint National Committee (JNC VII). Stepwise logistic regression analysis revealed, the calendar year 2014 (odds ratio [OR] = 3.23, P < 0.001), polytherapy (OR = 2.5, P < 0.001), and the level of SBP ≥140 mmHg (OR = 1.82, P < 0.01) as the three major predictors which showed a likelihood of switching medication. CONCLUSIONS: Findings of the study reveals predictors of the switchover like uncontrolled SBP, duration of HTN, compliance with the list of NLEM drugs, polytherapy, enabling the clinicians to critically analyze the patients' profile, and hence, reach target BP soon, i.e., decreased cardiovascular risk.
No takes yet. Share an insight, caveat, or question.
Bharatraj et al. (2017) conducted a cross-sectional in Hypertension (n=429). Antihypertensive drug prescription and clinical predictors (calendar year 2014, polytherapy, uncontrolled SBP, duration >5-10 years, noncompliance to NLEM) vs. Nonswitchers / reference clinical characteristics (2012 prescriptions, monotherapy, controlled SBP, NLEM compliance) was evaluated on Switching of antihypertensive therapy within 180 days from the date of first prescription (OR 3.23 for calendar year 2014; OR 2.5 for polytherapy; OR 1.82 for SBP ≥140 mmHg, p=<0.001). Antihypertensive drug switching occurred in 38.5% of patients within 180 days, driven primarily by 2014 prescriptions (OR 3.23), polytherapy (OR 2.5), and uncontrolled SBP ≥140 mmHg (OR 1.82).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: