Drug utilization and blood pressure control in ambulatory hypertensive patients: focus on those with compelling indications

Objective: Compelling indications require the use of specific antihypertensive drug classes and often two or more antihypertensive medications for blood pressure ( BP) control. This study assessed drug utilization patterns among hypertensive patients with compelling indications, conformity with recommended guidelines, and the effect on BP control. Materials and methods: A prospective, cross-sectional study of hypertensive patients attending three subspecialty hospital clinics. Data on demographics, prescriptions, and BP were collected. BP control was defined as BP less than 140/90 mmHg in nondiabetic subjects and less than 130/80 for those with diabetes. Analysis was done with SPSS version 17. Results: Of the 1,926 patients with hypertension, 877( 45.5%) had compelling indications. Patients were aged 59.3 +/- 11.5 years. The most frequently-encountered compelling indications were hypertensive heart disease( 35.8%), diabetic mellitus( 31.9%), and renal diseases( 11.5%). The most prescribed drug was angiotensin-converting enzyme inhibitor( ACEIs), which was present in 22.6% of all prescriptions. Only 23.1% of patients had fully controlled BP. Poor BP control significantly correlated with the number of antihypertensive drugs r = 0.205, p < 0.001, but negatively correlated with age and duration of hypertension, r = -0.071, p = 0.038 and r = -0.448, p = 0.042, respectively. Conclusion: BP control was very poor in this study, and there was a high prevalence of compelling indications. Poor control was negatively correlated with increasing age and duration of hypertension. The most common compelling indications were hypertensive heart disease, diabetes mellitus, and renal disease.