Comparison of Prescribing Pattern of Anti-hypertensive Drugs and the Level of Control Achieved in Type 2 Diabetes Patients between Primary and Tertiary Care Hospitals

Abstract

Hypertension is a common co-morbidity of diabetes affecting majority of people with diabetes, also a major risk factor for coronary vascular disease and microvascular complications such as retinopathy and nephropathy. To compare prescribing pattern of anti-hypertensive drugs and the level of control of hypertension achieved in type 2 diabetes patients in primary and tertiary care hospitals. Fifty patients each with type 2 diabetes and hypertension (fulfilling JNC 7 criteria for diagnosis of hypertension) attending the out-patient departments of primary and tertiary health care centers in Bangalore were included in the study. Data regarding blood pressure and type of drugs used were collected. Two blood pressure readings were taken with a time span of 5 min on each individual in sitting position. Average of the two readings was recorded. Only 34(68%) of patients were on treatment at primary care level where as 48(96%) were on treatment at tertiary care level. At the primary care level calcium channel blockers (CCBs) 20(40%) were the most common drug used followed by Angiotensin converting enzyme inhibitors (ACEI) 8(16%). At tertiary care level ARBs 22(44%) were the most commonly used drugs followed by ACE inhibitors 14(28%). Only 8(16%) were well controlled in primary care level whereas 34(68%) were well controlled at tertiary care level. Prescribing pattern of anti-hypertensives and level of control of hypertension at primary care level grossly deviates from available recommendations as compared to tertiary care level.

Keywords: anti-hypertensive drugs, type 2 diabetes mellitus, prescribing patterns, primary and tertiary health care levels