A Retrospective Study on Use of Antihypertensive drugs in Type 2 Diabetes Mellitus – A Hospital Based Study
Background: Association of Hypertension and diabetes has already been established. Hypertension is risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Therefore, Hypertension control is vital to prevent and retard progression of microvascular and macrovascular complications. With this aim, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute.
Materials & Methods: This study was conducted on diabetic patients suffering from hypertension as well. Analysis of Antihypertensive drugs prescriptions was undertaken in all diabetic patients with hypertension reporting to OPD at Department of Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India. Results: Of 125 patients screened initially, only 100 were eligible for participation. Out of n=100 patients, 58 were males and 42 were females. Mean age of group was 55.2 years. 38 (38%) patients were on monotherapy and remaining 62 (62%) patients were on combination antihypertensive drugs. There were a total of n= 170 antihypertensive drug exposures. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in 74% 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.
Copyright (c) 2018 International Archives of BioMedical and Clinical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.