Trends in Prescribing Antihypertensive Medications and Lipid Lowering Therapy in type-2 Diabetic Patients in South Indian Tertiary Care Hospital

 

Leelavathi D Acharya1*, N R Rau2, N Udupa1, Surulivel Rajan M1, Vijayanarayana K1

1Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal

2Department of Medicine, Kasturba Medical College, Manipal University, Manipal

*Corresponding Author E-mail: Leela.da@manipal.edu

 

 

ABSTRACT:

Objectives: To evaluate trends in prescribing antihypertensive medications and lipid lowering therapy in type 2 diabetic patients

Methods: The study was conducted as cross sectional observational study. The drug utilization data was collected for the years 2008 to 2010 after obtaining ethical committee approval. Collected data were analyzed using appropriate statistical techniques.

Results:  As per the study criteria, data were collected from 773, 700 and 647 type 2 diabetic patients who were admitted during the years 2008, 2009 and 2010 respectively in the medicine wards. Overall 56.53% diabetic patients had hypertension. Majority of them were males (61%), maximum number (36%) of diabetic hypertensive patients are in the age group of 55-64 years and about 39% patients had history of 1-5 years of hypertension. On evaluation of prescription pattern of antihypertensive medication in diabetic patients, most of the patients were on monotherapy and they are on calcium channel blockers (CCBs). Among CCBs amlodipine was commonly prescribed drug. About 30% of diabetic patients were on lipid lowering drugs.

Conclusion: In diabetic patients with hypertension, calcium channel blockers were preferably used contrary to the guidelines which usually recommend ACE inhibitors or ARBs in these patients.

 

KEYWORDS: Trends, prescription pattern, antihypertensive, lipid lowering therapy, type 2 diabetes mellitus.

 

 

INTRODUCTION:

Hypertension is seen in about 60% of type 2 diabetic patients. Serious cardiovascular events are two times higher in patients with diabetes and hypertension compare to either disease alone. Hypertension and dyslipidemia in type 2 diabetes mellitus (DM) also contribute to increased risk of coronary artery disease. It may be 2.3 times more in men and 2.9 times more in women with type 2 DM compared to nondiabetic people. This has been clearly given importance in therapeutic guidelines for the management of hypertension or dyslipidemia 1.

 

Appropriate use of antihypertensive drugs may improve Blood Pressure (BP) control and reduce the complications in patients with diabetes. Evidence also supports the need for using multiple antihypertensive agents rather than monotherapy to achieve target BP control and for renal-protection. In addition, more recent data from the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT) highlight the regular use of multidrug regimens to treat BP to achieve target levels, particularly in type 2 DM 2.

 

Results of United Kingdom Prospective Diabetes Study (UKPDS) published in 1998 showed benefit from controlling BP in type DM patients will reduce the onset and progression of microvascular and macrovascular complications. Also it reports, the Angiotensin Converting Enzyme (ACE) inhibitors, captopril and the beta blocker, atenolol appeared to be of equal efficacy in the treatment of hypertension in diabetes patients, but other studies suggests that ACE inhibitors or angiotensin receptor antagonists (ARBs) will decrease the proteinuria and delay the onset of nephropathy in patients with type 2 DM 3.

 

Heart Outcomes Prevention Evaluation (HOPE) study suggested that the use of an ACE inhibitor (Ramipril) prevents various complications of diabetes mellitus and had advantage in decreasing the incidence of myocardial infarction, stroke, nephropathy as well as cardiovascular and all-cause mortality 4.

 

Evidence shows that there is an advantages from cholesterol-lowering therapy using statin drugs in patients with DM in the prevention of cardiac accidents. In the Heart Protection Study, diabetes patient treated with simvastatin showed a reduction in new coronary events, revascularization and strokes even in patients who had normal cholesterol concentrations 5.


 

Table1: Demographic characteristics of diabetic patients

Demography characters

Classification

Number of patients(%) with DM+HTN

2008(n=419)

2009(n=441)

2010(n=339)

 

 

Age  Group(years)

<44

18(4.3)

30(6.8)

16(4.7)

45-54

97(23.2)

95(21.6)

70(20.6)

55-64

149(35.6)

158(35.8)

124(36.6)

65-74

113(26.9)

105(23.8)

82(24.2)

75-84

36(8.6)

45(10.2)

42(12.4)

>85

6(1.4)

8(1.8)

5(1.5)

Gender

Male

260(62.1)

272(61.7)

202(59.6)

Female

159(37.9)

169(38.3)

137(40.4)

Duration of diagnosis      ( years)

Newly  diagnosed

28(9.2)

40(16.4)

31(14.6)

1-5

139(45.9)

90(36.9)

75(35.2)

6-10

78(25.7)

61(25.0)

60(28.2)

>10

58(19.1)

53(21.7)

47(22.1)

Mean Blood Pressure (mm Hg)

Mean systolic BP ±  SD

141.16  ±20.218

140.41  ±21.326

140.10 ±21.217

Mean diastolic BP ± SD

85.49  ±11.668

85.4  ±11.078

85.02 ±11.877

 

 

 

Table 2a: Trends in prescribing monotherapy and two drug combinations of antihypertensive drugs in diabetic hypertensive patients

Regimen

Number of patients (%)

 

p-value

2008           N=419

2009         N=441

2010         N=339

No drugs

50(11.9)

74(16.8)

60(17.7)

 

Monotherapy

201(48.0)

207(46.9)

126(37.2)

 

 

 

 

 

0.114

 

CCBs(C)  

79(18.9)

98(22.2)

68(20.1)

Beta blockers (B)

28(6.6)

20(4.5)

12(3.5)

ACE Inhibitors (A)

42(10.0)

44(10.0)

18(5.3)

Angiotensin II receptor blockers (G)                                                  

46(11.0)

34(7.7)

21(6.2)

Diuretics (D)                                                                                      

4(1.0)

8(1.8)

4(1.2)

Alpha I blockers I                                                                              

1(0.2)

2(0.5)

2(0.6)

Centrally Acting (I)    

1(0.2)

1(0.2)

1(0.3)

Two-drug combinations          

106(25.3)

113(25.6)

104(30.7)

 

 

 

 

 

 

 

 

 

 

 

0.782

 

C+A                       

17(4.1)

13(2.9)

17(5.0)

C+B                        

17(4.1)

9(2.0)

14(4.1)

C+C

2(0.5)

-

-

C+D

5(1.2)

15(3.4)

11(3.2)

C+E

4(1.0)

5(1.1)

3(0.9)

C+G

15(3.6)

10(2.3)

13(3.8 )

C+I

3(0.7)

6(1.4)

4(1.2)

A+B                          

11(2.6)

10(2.3)

3(0.9 )

A+D                          

4(1.0)

13(2.9)

9(2.7 )

A+E                          

3(0.7)

3(0.7)

1(0.3 )

A+G                          

1(0.2)

-

1( 0.3)

B+D                         

7(1.7)

6(`1.4)

9(2.7 )

B+G                        

5(1.2)

6(1.4)

5(1.5 )

D+D    

2(0.5)

-

-

D+G

4(1.0)

10(2.3)

8(2.4)

G+I                           

1(0.2)

2(0.5)

2(0.6 )

G+E                         

-

-

2(0.6 )

D+E                                                                                                 

1(0.2)

2(0.5)

1(0.3 )

D+I                                                                                                  

1(0.2)

1(0.2)

1( 0.3)

E+I

1(0.2)

2(0.5)

-

B+E

1(0.2)

-

-

A+I

1(0.2)

-

-

 

 

 

There are various guidelines available for the management of type 2 DM with hypertension and with raised cholesterol etc.  Actual practice may deviate from recommended standards based on the results of clinical trials/ experience. Variations in actual practice compared to standard guidelines will help in developing local practice guidelines for particular disease based on the evidence1.

 

OBJECTIVE:

To evaluate trends in prescribing antihypertensive medications and lipid lowering therapy in type 2 diabetic patients.

 

Table 2b: Trends in prescribing three drug combinations of antihypertensive drugs in diabetic hypertensive patients

Regimen

Number of patients (%)

 

p-value

2008

N=419

2009

N=441

2010

N=339

Three drug

combinations

52(12.4)

40(9.1)

43(12.7)

 

 

 

 

 

 

 

 

 

 

 

 

0.858

C+A+D

1(0.2)

3(0.7)

4(1.2)

C+ A+I

3(0.7)

1(0.2)

2(0.6)

C+B+D

3(0.7)

3(0.7)

5(1.5)

C+B+G

2(0.5)

2(0.5)

1(0.3)

C+C+D

1(0.2)

-

-

C+D+G

7(1.7)

1(0.2)

2(0.6)

C+D+I

2(0.5)

10(2.3)

4(1.2)

A+B+D

5(1.2)

4(0.9)

4(1.2)

A+D+D

5(1.2)

-

-

B+C+G

1(0.2)

-

-

B+D+E

1(0.2)

-

2(0.6)

B+D+G

4(1.0)

2(0.5)

2(0.6)

B+D+I

1(0.2)

-

2(0.6)

D+D+D

1(0.2)

-

-

D+D+I

1(0.2)

-

-

D+D+E

1(0.2)

-

-

C+E+I

1(0.2)

1(0.2)

1(0.3)

C+G+E

-

1(0.2)

1(0.3)

A+E+I

-

-

1(0.3)

C+G+I

1(0.2)

-

2(0.6)

B+G+E

-

-

1(0.3)

B+E+I

-

-

1(0.3)

C+D+E

1(0.2)

6(1.4)

2(0.6)

C+A+G

-

-

2(0.6)

A+B+C

5(1.2)

3(0.7)

3(0.9)

A+B+G

1(0.2)

1(0.2)

-

A+D+E

-

1(0.2)

-

A+D+I

1(0.2)

1(0.2)

-

C+B+E 

-

-

1(0.3)

B+C+I

1(0.2)

-

-

B+B+G

1(0.2)

-

-

A+C+E

1(0.2)

 

 

 

METHODS:

A cross sectional observation study was carried out in the General Medicine units of tertiary care hospital in South India, which is multispecialty hospital. Ethical committee approval obtained from the Institutional Ethical Committee. Type 2 Diabetic patients with hypertension and dyslipidemia admitted in medicine wards during study period (2008 to 2010) included for the study as per study criteria. Patient data was collected prospectively over a period of three years (2008-2010). For data collection, each patient’s data were reviewed and data were documented in the CRF form prepared for study purpose. These diabetic patients were monitored from day of admission till day of discharge. Collected data for type 2 diabetic patients with hypertension and dyslipidemia were evaluated for trends in prescription of antihypertensive medications and lipid lowering therapy in type 2 DM patients using ‘SPSS version 20’.

 

Statistical Analysis:

Parametric data were presented as mean±SD and nominal data were presented as frequency and percentage. Trends in antihypertensive and lipid lowering therapy were analysed by Chi square test (Liner-by-linear association), p<0.05 was considered statistically significant.

 

Table 2c:  Trends in prescribing four and five drug combinations of antihypertensive drugs in diabetic hypertensive patients

Regimen

Number of patients (%)

 

p-value

2008

N=419

2009

N=441

2010

N=339

Four  drug

combinations

8(1.9)

4(0.9)

4 (1.2)

 

 

 

 

 

 

0.886

A+B+D+I

1(0.2)

-

1(0.3)

C+B+D+D

1(0.2)

-

-

C+B+D+E

3(0.7)

1(0.2)

-

C+D+D+I

1(0.2)

-

-

C+D+B+I

-

-

1(0.3)

C+D+A+E

-

-

2(0.6)

A+B+C+D

-

1(0.2)

-

C+A+D+I

-

1(0.2)

-

C+B+G+I

-

1(0.2)

-

A+C+G+I

1(0.2)

-

-

B+D+I+G

1(0.2)

-

-

Five drug

combinations

2(0.5)

3(0.7)

2(0.6)

 

 

 

0.717

C+D+D+E+I                                                                                          

1(0.2)

-

-

C+A+D+E+I

-

2(0.5)

1(0.3)

C+B+G+E+I

-

-

1(0.3)

C+A+D+G+B

-

1(0.2)

-

A+B+C+D+D

1(0.1)

-

-

 

RESULTS:

Kasturba Hospital, Manipal is a 2000 bedded multidisciplinary hospital. Present study was carried out in the Department of Medicine during the year 2008 to 2010. As per the study criteria, data were collected from 773, 700 and 647 patients of type 2 DM with or without hypertension and dyslipidemia who were admitted during the year 2008, 2009 and 2010 respectively in the medicine wards. Collected data were analyzed for following parameters.

 

 

Prevalence of HTN in Diabetic Patients:

Among 773 DM patients admitted during 2008, 419(54.2%) patients had hypertension. Of the 700 DM patients admitted during 2009, 441(63%) patients had hypertension and among 647 DM patients admitted during 2010, 339(52.39%) patients had hypertension. Overall prevalence of Hypertension in diabetic patients was 56.53%.

Demography of Diabetes Patients with Hypertension:

Most of the patients were in the age group of 55-64 years, which is 35.6% in 2008, 35.8% in 2009 and 36.6% patients in 2010. It was observed that majority of the patients are males. 62.1% patients in 2008, 62.7% in 2009 and 59.6% in 2010.  On evaluation of history of hypertension in these patients, most of the patients had history of 1-5 years. Mean systolic BP was 140.56 mm Hg and mean diastolic BP was 85.30 mm Hg. Detail representation of demographic characteristics of diabetic with hypertensive patients shown in Table 1.

 

Treatment of Hypertension in Diabetic Patients:

On evaluation of prescription pattern of anti-hypertensive medication in diabetic patients, most of the patients are on monotherapy, that is 211(48%) in 2008, 207(46.9%) in 2009 and 126(37.2%) in 2010 and majority of them are on calcium channel blockers that is 79(18.9%) in 2008, 98(22.2%) in 2009 and 68(20.1%) in 2010 on calcium channel blockers. Other details of choice of antihypertensive drugs in type 2 DM patients represented in table 2a,b and c.

 

Usage pattern of individual anti-hypertensive medications:

On evaluation of trends in prescribing different classes of antihypertensive in type2 diabetic patients from year 2008-2010, maximum number of patients received calcium channel blockers(CCBs), that is 188(44.9%) in 2008, 199(45.1%) in 2009 and 169(49.9%) in 2010. Among CCBs, amlodipine was the commonly prescribed drug. 161(85.6%) in 2008, 163(81.9%) in 2009 and 143(84.6%) in 2010 received amlodipine. Other details of individual drug prescribing pattern shown in table 3.

 

Table 3: Usage pattern of individual anti-hypertensive medication in diabetic hypertensive patients

Drugs

Number of patients (%)

 

p-value

2008 (n=419)

2009 (n=441)

2010 (n=339)

Calcium channel blockers (CCBs)

188 (44.9)

199 (45.1)

169 (49.9)

 

 

 

 

 

 

 

0.168

 

Amlodipine

161(85.6)

163(81.9)

143(84.6) 

Nifedipine

10(5.3)

2(1.0)

3(1.8)

Diltiazem

13(6.9)

19(9.5)

17(10.1)

Combination of CCBs

2(1.1)

14(7.0)

2(1.2)

Lercardipine

2(1.1)

-

0

Verapamil1(0.6)

-

-

1(0.6)

Nicardipine

-

1(0.5)

1(0.6)

clinidipine

-

-

2(1.2)

ACE inhibitors

107(25.5)

98(22.2)

64(18.9)

 

 

 

0.054

Ramipril

59(55.1)

73(74.5)

43(67.2)

Enalapril

38(35.5)

23(23.50

17(26.6)

Lisinopril

9(8.4)

1(1.0)

4(6.2)

Fasinopril

1(0.9)

-

-

Captopril

-

1(1.0)

-

Diuretics

73(17.4)

93(21.1)

73(21.5)

 

 

 

 

0.943

Frusemide

15(20.5)

36(38.7)

22(30.1)

Torsemide

16(21.9)

19(20.4)

15(20.5)

Hydrochlorothiazide

18(24.7)

13(14.0)

16(21.9)

Chlorthalidone

2(2.7)

-

2(2.7)

Spiranolactone

7(9.6)

2(2.2)

1(1.4)

Two diuretics

13(17.8)

15(16.1)

11(15.1)

Acetazolamide

-

-

6(8.2)

Metalzone

1(1.4)

2(2.2)

-

Indapamide

1(1.4)

4(4.3)

-

Three diuretics

-

2(2.2)

-

Angiotension II receptor blockers

91(21.7)

74(16.8)

69(20.4)

 

 

 

0.247

 

Olmesartan

2(2.2)

3(4.1)

5(7.2)

Losartan

75(82.4)

46(62.2)

46(66.7)

Telmisarton

14(15.4)

24(32.4)

16(23.2)

Irbesartan

-

1(1.4)

2(2.9)

Beta blockers

102(24.3)

72(16.3)

68(20.1)

 

 

 

0.707

Metoprolol

39(38.2)

36(50.0)

27(39.7)

Propranolol

3(2.9)

1(1.4)

3(4.4)

Atenolol

43(42.2)

24(33.3)

27(39.7)

Nebivolol

8(7.8)

6(8.3)

6(8.8)

Carvedilol

8(7.8)

4(5.6)

3(4.4)

Bisoprolol

-

-

2(2.9)

Combination of β-blockers

1(1.0)

1(1.4)

-

α1    blockers

21(5.0)

26(5.9)

23(6.8)

 

0.971

Prazosin

21(100)

25(96.2)

23(100)

Prazosin + doxazocin

-

1(3.8)

-

Centrally acting α2 blockers

25(6.0)

29(6.6)

28(8.3)

 

clonidine

25(100)

29(100)

28(100)

 

Table 4: Age group wise distribution of diabetic hypertensive patients who were prescribed different classes of antihypertensive drugs

Age group wise patients distribution

Total number of patients=1199

Age groups in years

<44

45-54

55-64

65-74

75-84

>85

DM with hypertension

64

262

431

300

123

19

CCBs

26(35.9)

117(44.6)

203(47.0)

148(49.3)

67(54.47)

7(36.84)

β-blockers

7(10.9)

52(19.8)

91(21.1)

74(24.6)

18(14.6)

4(21.05)

ACEIs

20(31.2)

69(26.3)

105(24.36)

58(19.3)

22(17.8)

1(5.26)

ARBs

8(12.5)

51(19.4)

86(19.9)

62(20.6)

25(20.3)

2(10.5)

Diuretics

10(15.6)

50(19.0)

86(19.9)

67(22.33)

25(20.3)

6(31.5)

Alpha Blockers

5(7.8)

14(5.34)

24(5.56)

20(6.6)

5(4.06)

3(15.7)

Centrally acting α2 blockers 

11(17.1)

21(8.0)

26(6.03)

19(6.3)

5(4.06)

0

All data presented as number of patients (%)

 

Age group wise distribution of type 2 diabetic patients with hypertension who were prescribed different classes of antihypertensive medications:

On evaluation of prescription pattern of anti-hypertensive medications in different age group of patients of type 2 DM with hypertension, it showed calcium channel blockers are the most commonly prescribed anti-hypertensive medication in all the age groups. Detail representation made in the Table 4

 

Prescription pattern of lipid lowering agents in type 2 diabetic patients

Most of diabetic patients received statins as lipid lowering therapy, that is 231(29.9%) in 2008, 173(24.71%) in 2009 and 194(30%) in 2010 on statins, details Data represented in Table 5.

 

Table 5: Usage pattern of lipid lowering agents in Type 2 diabetic agents

Drugs

Numbers of patients (%)

p-value

2008

2009

2010

No lipid

lowering agents

517(66.9)

520(74.3)

433(66.9)

 

 

 

0.947

 

Statins

231(29.9)

173(24.71)

194(30.0)

Fibrates

16(2.1)

7(1.0)

16(2.5)

Statin

+ fibrate

6(0.8)

-

4(0.6)

Atorvastatin + Ezetimibe

3(0.4)

-

-

Total

773

700

647

 

 

DISCUSSION:

The presence of hypertension in diabetic patients will increase the risk of microvascular and macrovascular complications. This was substantiated by UKPDS1998 and Hypertension Optimization Treatment (HOT) trials6,7. Recent guidelines suggest the goal of blood pressure in diabetic patients is below 130/80 mmHg. Hypertension and diabetes are interrelated disorders and independent risk factors associated with cardiovascular disease, cerebrovascular disease, peripheral vascular disease and renal disorders8.

 

As per seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure, diabetes is considered as one of the compelling indications and all the five classes of drugs (ACEIs, ARBs, CCBs, BBs and Diuretics) can be prescribed in the hypertension with diabetes9.

 

All the evidence shows that, ACEIs or ARBs are preferred first line agents for controlling hypertension in diabetes. When there is a need for combination therapy, thiazide-type diuretics should be added as second agent 1,10. Clinical practice may differ from these guidelines. Therefore present study was aimed to observe the pattern and trend in prescribing antihypertensive drugs in diabetic patients in Kasturba Hospital, Manipal.

 

In present study, we observed that, prevalence of hypertension in diabetic patient was around 50-60 % during the study period. Overall it showed that more than 50% of diabetic patients had hypertension. Published studies have shown that the prevalence of hypertension ranged from around 30% to 80% 1, 11, 12-14.

 

Present study also observed that majority of diabetic hypertensive patients are above 55 years of age, i.e. 72.5% in 2008, 71.6% in 2009 and 74.7% in 2010.  BP values increase with age and hypertension is very common in elderly10,15. Other published studies also have shown that most of diabetic hypertensive patients were around that age of 65 years 1, 2, 8, 11, 12, 16-18.

 

The overall incidence of hypertension was similar between men and women. , but varies depending on age. The percentage of men with high BP is higher than that of women before the age of 45. However, after the age of 64, higher percentage of women have high BP than men10. Our study has showed more male patient had diabetes with hypertension. Number of studies have shown either male or female predominance. It can be inferred that it is possible for both men and women to have hypertension with diabetes 2, 11, 14, 19, 13, 12, 20.

 

Mean systolic BP was around 140 mmHg was observed in the present study. Mean diastolic BP was around 85 mmHg.  In a study conducted  in  the Netherlands by Grieving  et al reported that mean systolic blood pressure of their study population was around 150 mmHg and the mean diastolic pressure was around 80mmHg 11.

 

As per the JNC 7 Guidelines, the target BP in Diabetic with Hypertensive patients was < 130/80mmHg. HOT (hypertension Optimal Treatment) trial suggest that intensive blood pressure reducing will help in prevention of cardiac complications in hypertensive patients 6. Patients have to be treated accordingly, to achieve target BP in study population.

 

Present study showed that mono-therapy with antihypertensive drugs was more common compared to combination therapy. It was 48% in 2008 and 46.9% in 2009 and 37.2% in 2010.  Among mono-therapy, CCBs were most commonly prescribed class of drugs. ACEIs and ARBs were the next most prescribed. As per JNC7 guidelines, ACEIs, ARBs, CCBs, Thiazide type diuretics and BBs can be considered for treatment of hypertension in diabetic patients. In UKPDS study, they compared β-blockers with ACEIs, and there was no difference in efficacy in reducing BP and also in reducing complications in these two groups of drugs 9,7.

 

Many trials and studies revealed that tight control of BP in diabetic patients required combination therapy7.  Among combination therapy we observed that two drug combinations were most commonly used. Among the two drug combinations, the commonly used combinations were CCBS with ACEIs and CCBs with other anti-hypertensives. According to published trials and evidence, the combination of an ACEI and CCB was superior to other combinations21-23. Treatment pattern in our setting mirrored these evidences. Using low-dose combinations of agent with different mechanisms is reported to be beneficial.  The ON-TARGET trial demonstrated that the combination of an ACE inhibitor with an ARB resulted in no additional benefit24. Under no circumstance should two drugs from the same class of medications be used to treat hypertension10. There is no change in trends in prescribing antihypertensive medication in type 2DM patients either monotherapy (p=0.0114) or dual therapy (p=0.782). Even there is no change in prescription pattern while using more than two drug combinations over a period of three years.

 

CCBS were prescribed most commonly over a period of three years either as monotherapy or as a combination therapy, followed by ACEIs. And there no change in the pattern of prescribing over a period of three years (p=0.168). Amlodipine (84%) was the commonest CCB’s prescribed among study population. FACET trial suggested that CCBs are not safe in diabetes since they may increase the risk of coronary artery disease and mortality. But in our setting, there is a preference for calcium channel blockers compared to other drugs and there is a need to change this prescription behavior.

 

In case of ACEIs, downward trend was observed from 2008-2010 (p=0.054). As per many studies, ARBs are better in diabetic hypertensive patients to protect from microvascular and macrovascular complications. It was used only in 13.8% cases.  Reno protective properties of losartan is reported in RENAAL and IDNT study25,26 and cardio protection in diabetic patients is reported in LIFE study27. Around 5% of patients were on clonidine (centrally acting α2 blocker). Although this class of drug was not recommended by any of the standard guidelines in diabetic hypertensive patients, some physicians prefer these drugs based on their experience. Αlpha-blockers may help in reducing lipid levels in diabetic patients 28.

 

There was no change in the prescription pattern of antihypertensive medications in elderly diabetic patients compared to other age groups and this was accordance with guidelines. Elderly patients are sensitive to certain adverse effects like volume depletion, sympathetic inhibition and orthostatic hypotension. Therefore centrally acting agents and α- blockers should preferably be avoided or used with caution in the elderly.

 

Evidence shows that there is an advantages from cholesterol-lowering therapy using statin drugs in patients with DM in the prevention of cardiac accidents29, 30. In this study we have seen the usage of statin in around 30% of patients similar to studies which have shown that statin use increased gradually to reach around 30% 11.

 

CONCLUSION:

Hypertension affected more than 50% of diabetic patients. Males (60 to 62%) are affected to greater extent than females (40 to 38%). Commonest antihypertensive drug used in mono-therapy was CCBs. Even though current recommendation favors ACEIs and ARBs as the drug of choice, ACEIs and ARBs were second most prescribed drugs in our study. 30% of patients were on statins for lipid lowering. There is no change in trend in prescribing antihypertensive medication and lipid lowering medication in diabetic patients over a period of three years. 

 

ACKNOWLEDGMENTS:

The authors would like to thank Head of all medicine units of Kasturba Hospital, Manipal for allowing to collect the data from their patient medical records

 

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Received on 18.05.2016          Modified on 30.05.2016

Accepted on 05.06.2016        © RJPT All right reserved

Research J. Pharm. and Tech. 2016; 9(7):857-863.

DOI: 10.5958/0974-360X.2016.00162.1