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Category: Volume 06 Issue 11 November 2018
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Title: Patterns of antihypertensive drug distribution of patients with hypertensive diabetes mellitus: A Hospital based observational study

Authors: Dr Yasmin Sultana Rahman, Dr N. P. Yadav

 DOI: https://dx.doi.org/10.18535/jmscr/v6i11.135

Abstract

Objectives: This present study was to evaluate the pattern of antihypertensive drug distribution as monotherapy, combination therapy and fixed dose combination of patients with hypertensive diabetes mellitus.

Methodology: A total of 100 patients of hypertensive diabetes mellitus were enrolled in this study. A detail history, complete assessment and relevant investigation were taken to all patients. Pattern of drug prescription was monotherapy, combination therapy and fixed dose combination.

Results: Data was analyzed by using simple statistical methods with the help of MS-Office software.

Conclusions: Patients of hypertensive diabetes mellitus was commonly seen in beyond 4th decades of life. Calcium channel blockers (amlodipine) and ACE inhibitors (Enalapril, ramipiril, lisinopril, levipril) were greatly prescribed in patients of hypertensive diabetes mellitus as monotherapy. AT II blocker with diuretics, ACE inhibitors with diuretics and β blocker with Calcium channel blocker were commonly used as combination therapy. And as a fixed dose combination therapy calcium channel blockers with angiotensine II receptor blocker and β blockers with diuretics were prescribed in majorities of patients with hypertensive diabetes mellitus. In mild to moderate HTN, the first line of treatment was lifestyle modification, i.e., weight control, low fat anti-atherogenic diet, salt restriction, reduction in alcohol intake, discontinuation of smoking, and some regimens of physical activity.

Keywords: Hypertension, Hypertensive diabetes mellitus, Antihypertensive drug prescription.

References

  1. Patel JC. Diabetes and its complications. J Diab Assn Ind 1985; 25: 16-25.
  2. Das S. Etiopathogenesis of hypertension in diabetes mellitus. Int J Diab Dev Count 1995; 15: 106-09.
  3. Rau NR, Acharya RV, Shah S. Incidence of diabetic complications in newly detected cases of NIDDM. Nova Nordisk Diabetes Update Proceedings 1999, Helath Care Communications, Bangalore 1999; 35-6.
  4. Sidhartha Das, Rina Mohanty, UK Patnaik. Management of Hypertension in Diabetes Mellitus. Journal, Indian Academy of Clinical Medicine. 2001; 2: 1.
  5. Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, eds. Diabetes Atlas. International Diabetes Federation. 3rd ed. Brussels, Belgium: International Diabetes Federation; 2006: 15-103.
  6. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365 (9455):217-23.
  7. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
  8. National Institutes of Health. Diabetes in America. In: NIH, eds. National Institutes of Diabetes and Digestive and Kidney Diseases. 2nd ed. Bethesda, MD: NIH Publication; 1995: 95-1468.
  9. Miller GJ, Maude GH, Beckles GLA. Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad. J Epidemiol Community Health. 1996;50(5):497-504.
  10. Khrime D et al. Antihypertensive drug utilization pattern and awareness in diabetic hypertensive patients at tertiary care centre. Int J Res Med Sci. 2015 Feb;3(2):461-465.
  11. UKPDS 38. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UK prospective diabetes study group. BMJ. 1998; 317(7160):703-13.
  12. James PA, Oparil S, Carter BL, Cushman WC, Dennison HC, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014;311(17):1809.
  13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul;34(28):2159-219.
  14. American Diabetes Association. Standards of medical care-2014. Diabetes Care. 2014 Jan;37(Suppl 1):S14-80.
  15. Curle JD, Pressel SL, Cutler JA et al. Effect of diuretic based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Programme Co-operative Research Group. JAMA 1996; 276: 1886-92.
  16. Tuomilehto J, Rastinyte D, This L, Staessen J, Reduction of mortality and cardiovascular events in older diabetic patients with isolated systolic hypertension in Europe treated with nitrendipine - based anti hypertensive therapy (Sys-Eur-Trial). Diabetes 1998; 47: A54.
  17. Hypertension in People with Type 2 Diabetes (non-insulin dependant diabetes) knowledge - based diabetes – specific guidelines, International Diabetes Federation (European Region) on behalf of the St Vincent Declaration Iniciative.
  18. Hansson I, Zanchetti A, Carruthers SG et al. For the HOTStudy Group, effect of intensive blood pressure lowering and low dose asprin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755-62.
  19. Mogensen CE. Combined high blood pressure and glucose in type 2 diabetics: double jeopardy. British trials show clear effects of treatment, specially blood pressure reduction. Selections from Br Med J 1999; 14: 984-9.
  20. George C, Wood NL, Blenkinsopp et al. Endocrine system, Editors: Mehta DK, Martin J, Donyai Furniss L et al. British National Formulary-38, September Edition, British Medical Association, Tavistock Square, London, WCIH 9 JP, UK andthe Royal Pharmaceutical Society of Great Britain, Lambeth High Street, London, SEI 7JN, UK 1999; 69-77, 82- 92: 311-15.
  21. Arya SN. The problems of hypertension in the elderly. J Indian Med Assoc 2000; 98: 171-4.
  22. Lawrence E, Ramsay B, Williams G et al. British Hypertension Society Guidelines for Hypertension Management 1999; Summary. Selections from Br Med J South Asia Edition 1999; 15: 758.
  23. Kaplan NM, Lieberman E. Hypertension and Diabetes, Obesity and Dyslipidaemia in Clinical Hypertension, 7th ed, New Delhi B.I. Waverly Pvt. Ltd 1998; 244-7.
  24. Hypertension in People with Type 2 Diabetes (non-insulin dependant diabetes) knowledge - based diabetes – specific guidelines, International Diabetes Federation (European Region) on behalf of the St Vincent Declaration Iniciative.
  25. Paul B, Sapra B, Maheswari S, Goyal RK. Role of losartan therapy in the management of diabetic hypertension. JAssoc Physicians India 2000; 48: 514-7.
  26. Mehta DK Martin J, Jordan B. Macfarlane CR. British National Formulary 43, British Medical Association , Tavistock Square, London WC IH 9JP,UK., 2002; 43: 95-7.
  27. Stanton A. ABCD Study , Calcium channel blockers. Br Med J 1998: 316: 1471-3.
  28. Kaplan NM. Treatment of Hypertension: Drugs-Therapy; Hypertension and diabetes. Kaplan NM, Lieberman E, Neal W, Kaplan’s Clinical Hypertension, Eighth Edition, 530 Walnut Street, Philadelphia, PA 19106 USA, Lippincott Williams and Wilkins, 2002; 314.
  29. Kumar S. RAAS in diabetes: therapeutic options, Chug S Clinical Medicine Update, New Delhi, South Asia Publishers Pvt Ltd 2002; 5: 93-8.
  30. Tatti P, Pahor M, Byington RP, Di Mauro F, Guarisco R, Strollo G, Strollo F: Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998;21:597– 603.
  31. Bakris GL, Barnhill, Sadler R: Treatment of arterial hypertension in diabetic humans: importance of therapeutic selection. Kidney Int 1992;41:912–919.
  32. Bakris GL, Weir MR, DeQuattroV, McMahon FG: Effects of an ACE inhibitor/calcium antagonist combination on proteinuria in diabetic nephropathy. Kidney Int 1998;54:1283–1289.
  33. Bakris GL, Williams B: Angiotensin converting enzyme inhibitors and calcium antagonists alone or combines: does the progression of diabetic renal disease differ? J Hypertens 1995;13(suppl):S95–S101.
  34. Epstein M: The benefits of ACE inhibitors and calcium antagonists in slowing progressive renal failure: focus on fixed-dose combination antihypertensive therapy. Ren Fail 1996;18:813– 832.
  35. SN Arya. Hypertension in Diabetic Patients – Emerging Trends. JIACM 2003; 4(2): 96-102.

Corresponding Author

Dr Yasmin Sultana Rahman

Post Graduate Trainee, Department of Pharmacology, Katihar Medical College, Katihar, Bihar, India

Ph: +91 8002736323, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.