Evaluation of Pattern of Antihypertensive Prescriptions and Adherence to JNC-7 Guideline in National Hospital Abuja-Nigeria

Abstract

Aim: To evaluate the pattern and acquisition costs of antihypertensive medications prescribed as well as adherence to JNC-7 guideline in management of hypertension. Study Design: This is a retrospective study to assess the patterns of prescription and cost analysis of antihypertensive drugs recommended by JNC-7 guidelines. Place and Duration of Study: Conducted at the Cardiology clinic of National Hospital           Abuja-Nigeria using case notes of hypertensive patients that were seen from May, 2015 to April, 2016. Methodology: Patients variables were collected using standardized data collection form. The average drug acquisition costs (ADAC) were calculated for each antihypertensive drug class Adherence to the guideline was calculated as a percentage of the total number of patients’ prescriptions that follow JNC-7 guideline. Results: A total of 318 patients fulfilled inclusion criteria, out of this majority were female (53.6%). Most of the patients fall within the age group of 44-58 years. The average age of the study population was 47.05 ± 8.59 years. The mean number of drugs per prescription in the study was 1.82 ± 0.64. There were no significant differences in the demographic data, with the exception of body mass index (BMI and) Age group (P<0.05). 44.3% of the patients were on combination therapy, while 30.5% and 25.2% were on monotherapy and fixed dose combination respectively. The most commonly prescribed antihypertensive drug class was Calcium Channel Blockers (36.76%) and most commonly prescribed fixed dose combination was that containing Calcium Channel Blockers and Angiotensin-2 Receptor Blockers (31.3%). There was significant difference in blood pressure outcome among patient on combination therapy and monotherapy as well as among patients whose prescription followed and did not follow the guideline (P<0.05). Adherence to the guideline occurred in 82.39% of the patients. The diuretics had the least acquisition cost in Naira (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensives prescribed. Similarly, monotherapy had the least acquisition cost in type of therapy. Conclusion: Calcium channel blockers were the commonly prescribed antihypertensive medications. Alpha-2 adrenergic receptor agonist had the lowest cost utilized per year. There was better blood pressure control in patients whose prescriptions followed JNC-7 guideline.