A comparative study of monotherapy versus combination therapy in patients with stage-1 hypertension in terms of efficacy and cost effectiveness and to assess the medication adherence

2018 ◽  
Vol 9 (1) ◽  
pp. 147 ◽  
Author(s):  
Ritu A Mathew ◽  
Samuel Johnson ◽  
Shalumol Jose ◽  
Shampa Chakraborty ◽  
Kenneth N ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Combination Therapy ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Cost Effective ◽  
Dual Therapy ◽  
Individual Therapy ◽  
Stage 1

Hypertension has multiple pathogenesis and majority of patients require two or more antihypertensive drugs to provide optimum control of blood pressure. The aim is to compare the effectiveness of mono therapy versus combination therapy in patients with stage-1 hypertension, to assess the medication adherence and to compare the cost incurred per day for the different therapies. Patient’s demographical details and history was recorded in a data entry form. Outcome of the treatment was measured in terms of reduction in systolic and diastolic blood pressure. Patient’s medication adherence was assessed using modified Medication Adherence Scale. Economic outcomes were measured in terms of cost of individual therapy. The data was entered into the excel sheet and statistically analysed using ANOVA. Results showed that dual therapy is the most effective in reducing the mean systolic (28.75 mm Hg) and diastolic (8.875) blood pressure with the combination of Amlodipine + Telmisartan being the most effective. Here, 66 patients (33%) were found to be adherent and 134 patients (67%) were found to be non- adherent. It was found that AMLOKIND 2.5, LOSAKIND and ATEN 50 were the most cost effective brands of drug from the classes of calcium channel blockers, angiotensin receptor blockers and beta blockers respectively. Comparison of effectiveness of various antihypertensive therapies showed that dual therapy shows maximum reduction in mean systolic BP and thus it can be prescribed more often in Stage I hypertensive patients. The poor adherence scores indicate that a multidisciplinary approach with a greater involvement of the patient is required to increase the compliance of the patient. Also cost effective drugs need to be prescribed more in order to decrease the financial burden on the patients. Keywords: Blood pressure; Monotherapy; Dual therapy; Triple therapy; Medication adherence

scholarly journals A Study to Evaluate Pharmacoeconomics of Antihypertensive Drugs in a Tertiary Care Teaching Hospital

2020 ◽  
Vol 10 (4-s) ◽  
pp. 176-180
Author(s):  
Nimmy N John ◽  
Athira Krishnan ◽  
JV Midhun ◽  
Riya Juan
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Financial Burden ◽  
Tertiary Care ◽  
Cost Effective ◽  
Effective Therapy ◽  
P Value ◽  
Major Public Health Problem ◽  
Care Hospital

Background: Hypertension is a major public health problem associated with large health burden as well as high economic burden at individual and population levels. A prospective observational study carried out in in-patients admitted to general medicine department of tertiary care hospital to evaluate the most cost effective therapy among the monotherapy of Amlodipine and combination therapy of telmisartan + hydrochlorthiazide. Methods: A total of 120 Hypertensive patients case records prescribed with monotherapy of Amlodipine and combination therapy of Telma H were reviewed and evaluated using descriptive statistics and ‘p’ value and assessed for their financial burden based on the cost per tablet for an year, Cost effectiveness ratio for the patients with controlled Blood Pressure by using a particular drug. Results: Out of 120 patients females were more (59.2%) and most of them were under the age group of 41-60 years. Majority of the patients had a known history of hypertension (65%). Most of the patients were prescribed with Telma H 40/12.5mg (40%) followed with Amlong 5mg (35.8%). There was a significant positive correlation (i.e., p value= 0.05) between persistence patterns of patients with drug therapy. Probability of patients with controlled Blood Pressure taking Amlong 10 mg were 82.35% followed by patients with Amlong 5mg. Conclusion: This study clearly showed that monotherapy of amlodipine is the most cost effective therapy than combination therapy of Telma H in order to reduce financial burden to the patient as well as to decrease the complications. Keywords: Hypertension, Pharmacoeconomics, Cost effectiveness, Blood Pressure.

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

scholarly journals An observational study on patient compliance and adverse drug reactions of antihypertensives drugs in a tertiary care center of Bihar

2021 ◽  
Vol 6 (4) ◽  
pp. 190-193
Author(s):  
Mrityunjay Kumar Pandit ◽  
Kumar Gaurav ◽  
Jeetendra Kumar
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Antihypertensive Drugs ◽  
Care Center ◽  
Adult Population ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Institutional Ethics

Hypertension is among the most common non-communicable and lifestyle disease in our country that affects adult population of both the genders from all socio-economic backgrounds and urban and rural population. In-spite of this, early diagnosis and appropriate treatment are suboptimal. Adherence of prescribed treatment has been studied in patients of hypertension in this study. : An observational and cross-sectional study was conducted in the Department of Pharmacology, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar. Prior to the initiation of the study, clearance was obtained from the Institutional Ethics Committee. Study period was between January 2021 and June 2021.A predesigned pretested interview schedule was used to collect the data from the 247 study participants. This schedule contained information related to socio-demographic variables, comorbidity, a format to assess the compliance to antihypertensive drugs prescribed and any adverse event. : A significant improvement in maintain optimal in blood pressure was observed in patients treated with one pill per day as compared to patients prescribed with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. : Low dose combination therapy has been stated to be more effective than high dose monotherapy in controlling blood pressure. It shows better compliance and lesser incidence of side-effects.

scholarly journals Drug utilization study of antihypertensive drugs and prevalence of blood pressure control in adult hypertensive patients based on JNC VIII guidelines in a tertiary care hospital: a cross sectional study

2019 ◽  
Vol 8 (2) ◽  
pp. 245
Author(s):  
Saumya Ramadas ◽  
M. B. Sujatha ◽  
M. A. Andrews ◽  
Sanalkumar K. B.
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Drug Utilization ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Care Hospital ◽  
Drug Utilization Study

Background: Hypertension is a major independent risk factor for coronary artery disease, congestive heart failure, stroke, chronic kidney disease and peripheral vascular diseases if left untreated. Drug utilization study of antihypertensive drugs and the study on prevalence of blood pressure control would help in reducing the burden of the disease and health expenditure.Methods: The study was conducted in the Outpatient Department of Medicine in Government Medical College, Thrissur. Patients aged 18yrs or above diagnosed with hypertension, on antihypertensive drugs were enrolled in the study. Patients suffering from secondary hypertension and acutely ill were excluded. Patients were enrolled after taking an informed consent. Demographic data, present treatment for hypertension, associated co- morbid conditions if any, and treatment of the same were recorded. BP was recorded, and cost of treatment was calculated using CIMS.Results: A total of 250 patients were included in the study. Mono therapy was used in 64.8% patients and combination therapy in 35.2%. Overall drug utilization pattern showed that CCBs (42.8%) were most commonly prescribed, followed by ACEIs (32.4%) and ARBs (29.2%). Most commonly prescribed combination therapy was ACE I + BB (29.3%), followed by ARB + CCB (21.3%). Mean cost of antihypertensive drug therapy was 3057.8 Rs / yr. Recommended target BP was achieved in 49.6% of patients.Conclusions: The prescription pattern of antihypertensive drug was in accordance to the JNC-VIII guidelines. The blood pressure target was achieved only in less than 50% of patients.

scholarly journals Azilsartan: Current Evidence and Perspectives in Management of Hypertension

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Akshyaya Pradhan ◽  
Ashish Tiwari ◽  
Rishi Sethi
Keyword(s):  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Daily Practice ◽  
Current Evidence ◽  
Hypertension Management ◽  
Angiotensin Receptor ◽  
Global Pandemic ◽  
Receptor Blockers

Hypertension continues to be global pandemic with huge mortality, morbidity, and financial burden on the health system. Unfortunately, most patients with hypertension would eventually require two or more drugs in combination to achieve their target blood pressure (BP). To this end, emergence of more potent antihypertensive drugs is a welcome sign. Angiotensin receptor blockers (ARBs) are cornerstones of hypertension management in daily practice. Among all ARBs, azilsartan is proven to be more potent in most of the head-to-head trials till date. Azilsartan is the latest ARB approved for hypertension with greater potency and minimal side effects. This review highlights the role of azilsartan in management of hypertension in the current era.

scholarly journals The new angiotensin II receptor blocker Edarbi® as part of the pathogenetic treatment of arterial hypertension in patients with metabolic disorders

2017 ◽  
Vol 14 (3) ◽  
pp. 28-35
Author(s):  
I Ye Chazova ◽  
Yu V Zhernakova ◽  
N V Blinova ◽  
A N Rogoza
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Angiotensin Receptor Blockers ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Metabolic Effects ◽  
Receptor Blocker ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Receptor ◽  
Stage 1

Relevance. Recently, the proportion of angiotensin receptor blockers has significantly increased among prescribed antihypertensive drugs. High organoprotective properties, additional metabolic effects and tolerability comparable to placebo make them the drugs of choice, especially in patients with stage 1 and stage 2 hypertension having low adherence to antihypertensive therapy, but already burdened by additional metabolic risk factors. Purpose of the study - study of the antihypertensive efficacy of the angiotensin receptor blocker azilsartan medoxomil (Edarbi®), its effect on cardiometabolic risk factors and damage of target organs in patients with stage 2 hypertension. Materials and methods. The study included 32 patients (mean age 47.32±8.4 years), 19 men and 13 women with stage 2 hypertension. All patients were evaluated for clinical blood pressure (BP), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, creatinine, glucose level in a carbohydrate tolerance test, 24-hour blood pressure monitoring, central aortic systolic pressure, сarotid-femoral pulse wave velocity and intima-media thickness was determined initially and after 6 months of therapy. Results. During taking Edarbi® 82% of patients with stage 1 and stage 2 hypertension and metabolic syndrome reached the target level of BP, which was accompanied by a significant improvement in diastolic function of the left ventricle in 56% of patients. Already in the first 6 months the treatment reduced arterial stiffness and improved metabolic control

scholarly journals The quality of life of chronic kidney disease patients with hypertension treated with angiotensin system-related agents

2020 ◽  
Vol 11 (4) ◽  
pp. 6633-6639
Author(s):  
Mohammed Salim KT ◽  
Saravanakumar RT ◽  
Dilip C ◽  
Amrutha KP
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
The Impact

The chronic kidney disease (CKD) co-exist with hypertension in approximately 80 to 85 per cent of patients. The CKD stages can be defined by glomerular filtration rate (GFR), and the deterioration of kidney function or reduction in GFR has observed in those with uncontrolled blood pressure (BP). We had conducted a prospective study to analyse the impact of the angiotensin system-related agents on the quality of life of CKD patients with hypertension. The SF-36 questionnaire, direct patients interview and medical records were the sources for retrieval of information. We observed that male patients were more prone to CKD than female. Hypertension was the primary (77.8%) aetiology behind the incidence of CKD. The angiotensin-converting enzyme inhibitors (ACEI) was responsible for very low (58%) and low (44%) health disabilities to the patients. In contrast, the angiotensin receptor blockers (ARB) even though it has a limited adverse effect, the patients complained of medium (9%) and high disabilities than the ACEIs. The discontinuation of the antihypertensive drugs by the CKD patients was almost negligible (3.4%). The study concludes that a balanced diet and reasonable blood pressure control is essential to prevent the progression of CKD and to improve the quality of life.

scholarly journals MANAGEMENT OF HYPERTENSION - AN AYURVEDIC REVIEW

2021 ◽  
Vol 9 (10) ◽  
pp. 2465-2471
Author(s):  
Garima Yadav ◽  
Pramod Kumar Mishra ◽  
Indu Sharma ◽  
Lekha Soni
Keyword(s):  
Blood Pressure ◽  
Dietary Habits ◽  
Antihypertensive Drugs ◽  
Medical Condition ◽  
Premature Death ◽  
Cost Effective ◽  
Systemic Blood Pressure ◽  
Arterial Disease ◽  
Treatment Modalities ◽  
Human Beings

Hypertension is the most common lifestyle disorder today. Systemic arterial hypertension is that the most important modifiable risk factor for all-cause morbidity and mortality. Worldwide one of the major causes of premature death is hypertension and can lead to major health consequences, such as CHD, CHF, peripheral arterial disease, stroke, renal failure, and death. Hypertension may be a chronic and sometimes asymptomatic medical condition during which systemic blood pressure is elevated beyond normal. Fewer than half of those with hypertension are conscious of their condition and lots of others are Modern treatment modalities are effective for the management of hypertension but pose human beings to their unwanted complications on their long-term use. The conventional antihypertensive drugs have many adverse effects & are not well tolerated which led to non-compliance, switching & discontinuation of treatment. There is no direct description of HTN in Ayurveda but based on its clinical presentation and similarity between pathogenesis factors for hypertension can be correlated with Raktagata Vata and it is considered as Tridoshaja Vyadhi. Treatment for hypertension in Ayurveda on the idea of Balancing all three Doshas. So Nidan Parivarajan, proper dietary habits, Yoga, Meditation along Ayurvedic herbs can be beneficial for balancing the state of mind, maintaining as well asreducing blood pressure. The Ayurvedic drug's potency depends upon rasa, Guna, Virya, Vipaka & Prabhava. Also, Acharyas have mentioned this as Prabhava of the drug. Ayurveda has various classical formulations and single herbs like Brahmi, Pushkarmoola, Jyotishamati, Sarpagandha, Saunf, Jatamansi etc. having Hridya, Kaphahara, Vatahara, Balya, Raktaprasadana, etc. properties which are safe and cost-effective too. Keywords: High Blood Pressure, Lifestyle disorders, Raktachapa, Silent killer.

Abstract 16061: Antihypertensive Therapy Prescribing Pattern Among Patients With Markedly Elevated Blood Pressure in a Real-world Setting

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yuan Lu ◽  
Chenxi Huang ◽  
Shiwani Mahajan ◽  
Cesar Caraballo ◽  
Erica S Spatz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Antihypertensive Drug ◽  
Guideline Adherence ◽  
Real World ◽  
Ace Inhibitor ◽  
Antihypertensive Drugs ◽  
Drug Prescription ◽  
Elevated Blood ◽  
Outpatient Visits

Introduction: Combination therapy with two or more antihypertensive agents is recommended for management of patients with markedly elevated blood pressure (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) by the 2017 AHA/ACC hypertension guideline. Using electronic health records (EHR) data from a large health system, we characterized real-world antihypertensive drug prescribing patterns and assessed guideline adherence among ambulatory patients with markedly elevated BP. Methods: Our cohort included patients aged 18-85 years with at least 2 outpatient visits in the Yale New Haven Hospital System between January 1 st , 2013 and December 31 st , 2018, resulting in a total of 665,691 patients. We defined the phenotype of markedly elevated BP as two consecutive outpatient visits with SBP ≥160 mmHg or DBP ≥100 mmHg. We described the number and class of antihypertensive drugs (previously taken and newly prescribed) at the second visit with BP ≥160/100 mmHg. Results: We identified 38,098 patients with markedly elevated BP with a mean age of 62.4 (SD: 13.7) years; 47.9% were male; and 67.8%, 20.9%, and 9.3% were White, Black and Hispanic. Among them, 49.3% were not on any antihypertensive drugs at the end of the second visit, 26.2% had one active antihypertensive drug prescription, and 24.5% had two or more agents prescribed (Figure). Among patients with two or more antihypertensive drug prescriptions, the most common drug class combination prescribed was diuretic/ACE inhibitor (10.2%), followed by diuretic/ARB (9.3%), and ACE inhibitor/calcium channel blocker (6.5%). The low prescription of combination therapy was consistent across age, gender, and race subgroups. Conclusions: Prescribing of guideline-recommended combination antihypertensive drugs for patients with markedly elevated BP is suboptimal. Major opportunities exist for improving the guideline adherence of antihypertensive drug prescription in this population.

scholarly journals COMPARATIVE PHARMACOECONOMIC RESEARCH AND EVALUATION OF ENALAPRIL GENERICS IN TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

2019 ◽  
pp. 55-60
Author(s):  
І. V. Sakhanda ◽  
K. L. Kosyachenko ◽  
Т. S. Nehoda ◽  
A. V. Kabachna ◽  
L. L. Davtian ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Arterial Hypertension ◽  
System Analysis ◽  
Antihypertensive Drugs ◽  
Generic Drugs ◽  
Financial Burden ◽  
Cost Effective ◽  
Economic Research ◽  
Modern Concept ◽  
Pharmacoeconomic Research

The number of people with cardiovascular diseases has increased significantly in recent years. According to statistics, diseases of the cardiovascular system occupy one of the first places among other diseases. One of the main pathologies in cardiology is hypertension. Treatment of arterial hypertension for a long period remains an important medico-social and economic task, a heavy financial burden falls on the patient himself or on the health care system, in the case of free distribution of drugs. The group of antihypertensive drugs is one of the most expensive, which raises the question of cost-effective therapy. Clinical and economic research that combines analysis of clinical efficacy and affordability is necessary for evidence-based, rather than empirical, choice of the drug. The most acceptable method of assessing the clinical significance of various drugs is a «cost-effectiveness» analysis. The article is devoted to the conducted pharmacoeconomic research, giving a comparative assessment of various enalapril generics. The objective of the work was to identify and justify the use of the most clinically effective and cost-effective generic drugs enalapril. The methodological basis of the research was the modern concept of marketing research of the drug market, the methodology of system analysis and scientific forecasting of economic phenomen. In the process of research, the methods of system, sociological, economic and statistical analysis, including absentee questionnaires, were used. As a result, sales of cardiovascular drugs on the pharmaceutical market were analyzed, the structure of enalapril generic consumption in health facilities was studied, and a pharmacoeconomic analysis («cost-effectiveness» method) of antihypertensive treatment of enalapril generics was conducted.

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