Use of Antihypertensive Drugs in Type 2 Diabetic Patients - A Hospital Based Study in Rajsamand
Introduction: Diabetes Mellitus has been closely associated with Hypertension. Hypertension is major risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Therefore, controlling Hypertension is vital to prevent and retard progression of microvascular and macrovascular complications. Therefore, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute.
Materials and Methods: This study was conducted on diabetic patients who had hypertension as well attending Medicine department of Ananta Institute of Medical Sciences & Research Center, Rajsamand, Rajasthan. Antihypertensive drugs were analysed on all diabetic patients reporting to medicine OPD from February 2016 to April 2016 at our institute were screened.
Results: Around 145 patients were included in our study. Out of 145 patients, only n=112 patients completed our study. Out of n=112 patients, 62 were males and 50 were females. Mean age of group was 52.5 years. N=33 patients were on monotherapy and remaining patients were on combination antihypertensive drugs. There were total 331 antihypertensive drug exposures. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in n=150 patients.
Conclusion: Our study showed that majority of diabetic hypertensive patients needed multiple drug therapy to control hypertension. Most of the patients were on ARBs/ACE inhibitors. This was according to recommendation by ADA or JNC8.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. American Diabetes Association. Standards of medical care-2014. Diabetes Care. 2014 Jan;37(Suppl 1):S14-80.
10. Ref Yuen YH, Chang S, Chong CK, Lee SC, Critchlev JA, Chan JC. Drug utilization in a hospital general medical outpatient clinic with particular reference to antihypertensive and antidiabetic drugs. J Clin Pharm Ther. 1998;23:287-94.
11. Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis. 2000;36(3):646-61.
12. Allhat Officers and Coordinators for the ALLHAT Collaborative Research Group, The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-97
13. Berlowitz DR, Ash AS, Hickey EC, Glickman M, Friedman R, Kader B. Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care. 2003;26(2):355-9.
14. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 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. 2007;28(12):1462-536.
15. Nather A, Bee CS, Huak CY, Chew JL, Lin CB, Neo S, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complicat. 2008;22(2):77-82.
16. Reiber GE. The epidemiology of diabetic foot problems. Diabet Med. 1996;13(Suppl 1):S6-11.
17. Shah J, Khakhkhar T, Bhirud S, Shah RB, Date S. Study of utilization pattern of antihypertensive drugs in hypertensive diabetic patients with or without reduced renal function at tertiary care teaching hospital. Int J Med Sci Public Health. 2013;2:175-80.
18. Dhanaraj E, Raval A, Yadav R, Bhansali A, Tiwari P. Prescription pattern of antihypertensive agents in T2DM patients visiting tertiary care centre in North India. Int J Hypertens. 2012;2012:520915.
19. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. New Engl J Med. 2000;342(3):145-53
20. Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Tameem EJ. Patterns of antihypertensive therapy in diabetic patients with and without reduced renal function. Saudi J Kidney Dis Transpl. 2010;21:652-9.
21. Johnson M, Singh H. Patterns of antihypertensive therapies among patients with diabetes. J G Intern Med. 2005;20(9):842-6.
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