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International Journal Of Medical, Pharmacy And Drug Research(IJMPD)

Drug Utilization Patterns of Anti Hypertensive agents in patients undergoing Hemodialysis in a Tertiary Care Hospital

Sravan. P , Sridevi. P , Anantha Lakshmi.G , Bindu.P , Saamiya Mehnaaz , Dharani Sathya , Syeda Uzma Nishath , Soma Sekhar.M , Bhagavan Raju. M

International Journal of Medical, Pharmacy and Drug Research(IJMPD), Vol-6,Issue-2, March - April 2022, Pages 35-41 , 10.22161/ijmpd.6.2.5

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Article Info: Received: 05 Feb 2022; Received in revised form: 06 Mar 2022; Accepted: 11 Mar 2022; Available online: 20 Mar 2022


Background: India is experiencing a rapid health transition and is projected to become a major reservoir of chronic diseases like Diabetes and Hypertension and 25 to 40% of these subjects may develop chronic kidney disease and end stage renal disease. Aim and objective of the study was to analyze utilization pattern of antihypertensive drugs in chronic kidney disease patients in a tertiary care hospital. Methods: The present observational cross-sectional study was conducted in Apollo hospitals, Jubilee hills, Hyderabad from 01.12.2019 to 31.05.2020 on patients with chronic kidney disease stage 5. The drug utilization pattern was studied with respect to age, sex, basic disease, duration of dialysis, type of antihypertensives used, etc. Comparison of mean between gender and dialysis / not on dialysis was done using unpaired ‘t’ test. A p value of < 0.05 was taken as statistically significant. Results: Of 100 patients, the data was analyzed with respect to age categories between 18-30 years; 31-40; 41-50; 51-60; 61-70; >70 years which accounted for 10%, 11%, 20%, 35%, 21% and 3% respectively. The patients between age group between 51-60 years were more prevalent compared to other age groups, based on gender distribution, majority of sample size were found to be males (62%) followed by females (38%). In our study sample, few subjects were found to be Overweight and obese subjects accounted for 33% and 20% respectively followed by subjects with normal BMI 44% and Underweight 3%.Almost all the subjects had Comorbidities. The profound ones were Dyslipidemia, Diabetes mellitus, Hypothyroid, CAD. The contribution of hypertension to medical morbidity and mortality is therefore enormous as it has been shown in other studies with stroke, anemia, Type 2 DM, and renal failure. It is the most common associated comorbid condition among many medical admissions. Most clinicians are often guided by their preference for any of the major guidelines available for the management of hypertension. Previously, diuretics were considered to be the first-line drugs. However, guidelines by the JNC VII recommend both CCBs as well as ACE-I as first-line drugs in addition to diuretics. Conclusions: In order to treat CKD, it is important to treat hypertension as hypertension and CKD are related to each other. Treatment of hypertension will help in controlling future development of comorbidities. Calcium channel blockers and centrally acting drugs are the treatment of choice in patients with CKD stage 5D with hypertension. Multi-drug antihypertensive therapy is a better choice than mono/single-drug antihypertensive therapy.

Drug Utilization Patterns, Hypertension, high blood pressure, Angiotensin receptor blockers.

[1] Agarwal R, Sinha AD: Cardiovascular protection with antihypertensive drugs in dialysis patients: Systematic review and meta-analysis. Hypertension 53: 860-866, 2009. Abstract/FREE Full Text Google Scholar
[2] Agarwal R, Weir MR: Dry-weight: A concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. C/in J Am Soc Nephrol 5: 1255-1260, 2010 Abstract/FREE Full Text Google Scholar
[3] Rohrscheib MR, Myers OB, Servilla KS, Adams CD, Miskulin D, Bedrick EJ, Hunt WC, Lindsey DE, Gabaldon D, Zager PG; DCI Medical Directors: Age-related blood pressure patterns and blood pressure variability among hemodialysis patients. Clin J Am Soc Nephrol 3:1407-1414, 2008 Abstract/FREE Full Text Google Scholar
[4] Agarwal R, Peixoto AJ, Santos SF, Zoccali C: Pre- and post dialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol 1: 389-398, 2006 Abstract/ FREE Full Text - Google Scholar
[5] Tandon T,Sinha AD, Agarwal R: Shorter delivered dialysis times associate with a higher and more difficult to treat blood pressure. Nephrol Dial Transplant 28: 1562-1568, 2013 Abstract/FREE Full Text Google Scholar
[6] Agarwal R, Nissenson AR, Batlle 0, Coyne OW, Trout JR, Warnock DG: Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 115: 291-297, 2003 CrossRef PubMed Google Scholar
[7] Agarwal R: Blood pressure and mortality among hemodialysis patients. Hypertension 55: 762-768, 2010 Abstract/FREE Full Text Google Scholar
[8] Heerspink HJ, Ninomiya T, Zoungas S, de Zeeuw D, Grobbee DE, Jardine MJ, Gallagher M, Roberts MA,Cass A, Neal B, Perkovic V: Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: A systematic review and meta-analysis of randomised controlled trials. Lancet 373: 1009-1015, 2009 CrossRef PubMed Google Scholar
[9] Alborzi P, Patel N, Agarwal R: Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol 2: 1228-1234, 2007 Abstract/FREE Full Text Google Scholar
[10] Amar J, Vernier I, Rossignol E, Bongard V, Arnaud C, Conte JJ, Salvador M, Chamontin B: Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients. Kidney Int 57:2485-2491 , 2000 CrossRef PubMed Google Scholar
[11] Levin NW, Kotanko P, Eckardt KU, Kasiske BL,Chazot C, Cheung AK, Redon J, Wheeler DC, Zoccali C, London GM: Blood pressure in chronic kidney disease stage 50- report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int 77: 273-284, 2010 CrossRef PubMed Google Scholar
[12] Tara I. Chang, Yuanchao Zheng, Maria E. Montez-Rath and Wolfgang C. Winkelmayer CJASN August 2016, 11 (8) 1401-1412; DOI: https://doi.org/10.2215/CJN.10611015
[13] Mahboob Rahman, M.D., M.S., Valerie Griffin, R.N. American Journal of Health-System Pharmacy, Volume 61, Issue 14, 15 July 2004, Pages 1473–1478, https://doi.org/10.1093/ajhp/61.14.1473.
[14] Wendy L St Peter, Stephen M Sozio, Tariq Shafi, Patti L Ephraim, Jason Luly, Aidan McDermott, Karen Bandeen-Roche, Klemens B Meyer, Deidra C Crews, Julia J Scialla, Dana C Miskulin, Navdeep Tangri, Bernard G Jaar, Wieneke M Michels, Albert W Wu, L Ebony Boulware & the DEcIDE Network Patient Outcomes in End-Stage Renal Disease Study Investigators. (BMC Nephrology volume 14, Article number: 249 (2013)
[15] Todd F Griffith MD, MHSaBenjamin S.YChua MBBS Andrew S Allen PhD Preston SK lassen MD, MHS Donal N Reddan MB, MRCPI, MHS Lynda A Szczech MD, MSCE American Journal of Kidney Diseases Volume 42, Issue 6, December 2003, Pages 1260-1269.
[16] Bhanu priya B and Basavanna PL, International Journal of Biomedical Research 2015; 6(04) : 251-254, www.ssjournals.com, Journal DOI:10.7439/ijbr,
[17] Harold J. Manley, Cory G. Garvin, Debra K. Drayer, Gerald M. Reid, Walter L. Bender, Timothy K. Neufeld, Sudarshan Hebbar, Richard S. Muther, Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider, Nephrology Dialysis Transplantation, Volume 19, Issue 7, July 2004, Pages 1842–1848, https://doi.org/10.1093/ndt/gfh280