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\def\citeauthor{~Akhila~Thorlikonda,
              ~Sri~Lakshmi~Gujjula,
              ~Jilshana~Thesni~P,
              ~Gireesh~P,
              ~Sashikanth~T}
\def\citetitle{\textbf{A Study on Drug Utilization Evaluation of Anti-Hypertensive's in the Cardiology ICU Department of a Tertiary Care Hospital}}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Akhila Thorlikonda et al.}
\firstPage{102}
\articleType{Original Article}
\receivedDate{10 Jun 2022}
\acceptedDate{30 Jun 2022}
\revisedDate{29 Jun 2022}
\journalVolume{2}
\journalIssue{3}
\copyrightYear{2022}
\eISSN{2583-0953}
\journalDoi{10.26452/ijcpms.v2i3.326}
\def\authorCount{5}
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\def\journalTitle{International Journal of Clinical Pharmacokinetics and Medical Sciences}

\title{\textbf{A Study on Drug Utilization Evaluation of Anti-Hypertensive's in the Cardiology ICU Department of a Tertiary Care Hospital}}
\author{Akhila~Thorlikonda\textsuperscript{*}\textsuperscript{1},  
            Sri~Lakshmi~Gujjula\textsuperscript{1},  
            Jilshana~Thesni~P\textsuperscript{1},  
            Gireesh~P\textsuperscript{2}, 
            Sashikanth~T\textsuperscript{3}~\\[5pt]{\textsuperscript{1}Nova College of Pharmaceutical Education and Research, Jupudi-521456, Andhra Pradesh, India}~\\{\textsuperscript{2}Department of Pharmacy Practice, Nova College of Pharmaceutical Education and Research, Jupudi-521456, Andhra Pradesh, India}~\\{\textsuperscript{3}Yashoda Multispeciality Hospital, Secunderabad-500003, Telangana, India}}

\begin{abstract}
Arguably, the most significant risk factor for cardiovascular, cerebrovascular, and renal illness is hypertension, which may be changed by prompt diagnosis and prompt treatment action. The Joint National Committee (JNC) on detection, assessment, and treatment of blood pressure is the body that proposes the guidelines for the management of hypertension. This 6-month, cross-sectional observational study included 219 participants and was conducted at Yashoda Multispeciality Hospital in Secunderabad. The purpose of the current study was to assess the usage of anti-hypertensives in hypertensive cardiology patients admitted to the intensive care unit at a tertiary care facility. According to the study, a large percentage of male hypertension patients also have co-morbid diabetes mellitus. Alpha+beta blockers were the most often given class of antihypertensive medications, followed by calcium channel blockers and diuretics. Regarding patient therapy, 27.0\% of patients were given monotherapy, while 53.0\% were given combination therapy, of which 20\% were given FDCs. According to the study's findings, clinical pharmacists can be crucial in fostering rational prescribing and enhancing drug adherence. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Hypertension,\newline Therapeutic Intervention,\newline Drug Utilization Evaluation,\newline JNC Guidelines
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Akhila~Thorlikonda~\\ Phone:\ 7672074936~\\  Email:\ akhilatorlikonda@gmail.com
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\section{Introduction}
A significant global public health concern is hypertension. By 2025, the World Health Organization (WHO) predicts that 1.5 billion individuals worldwide will likely have hypertension. According to several sources, 29\% of Indians are reported to have hypertension. In India, cardiovascular illnesses cause 1.5 million fatalities each year. 57\% of fatal strokes and 24\% of fatal coronary events are attributed to hypertension. The third most significant risk factor for disease burden in south Asia is hypertension. Perhaps the single most significant risk factor for cardiovascular, cerebrovascular, and renal illness is hypertension, which can be decreased by prompt identification and prompt treatment action \unskip~\cite{1544697:26083332,1544697:26083344}.

The Joint National Committee (JNC) on detection, assessment, and treatment of blood pressure has developed recommendations for treating hypertension. The Indian guidelines closely adhere to the JNC Guidelines and are supported by the Indian College of Physicians, the Indian Cardiology Society, and the Indian Society for Hypertension (JNC6 and JNC7). These recommendations, which are periodically revised based on information from scientific and clinical research, help doctors choose the best antihypertensive medication for each patient \unskip~\cite{1544697:26083337,1544697:26083341,1544697:26083340}. The influence that such guidelines have on the choice of therapeutic drugs may be evaluated and examined using pharmaco-epidemiological investigations like Drug Utilization and Prescription pattern studies. It has been noted that clinical practice does not fully incorporate evidence-based clinical research \unskip~\cite{1544697:26083339,1544697:26083333}, which can lead to less-than-ideal patient care practices \unskip~\cite{1544697:26083343,1544697:26083335} This study's goal is to track how antihypertensive medications are used at a tertiary care teaching hospital and compare the results to accepted medical practices.

A sustained increase in arterial blood pressure is referred to as hypertension. Adult blood pressure is categorized by the Eighth Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) as illustrated in Table~\ref{tw-ebc609fef8f3}\unskip~\cite{1544697:26083342,1544697:26083334}.


\begin{table*}[!htbp]
\caption{\boldmath {JNC8 Hypertension Classification} }
\label{tw-ebc609fef8f3}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4151\linewidth-2\tabcolsep}p{\dimexpr.29050000000000004\linewidth-2\tabcolsep}p{\dimexpr.2944\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Category & \cAlignHack Systolic (mm Hg) & \cAlignHack Diastolic (mm Hg)\\
\tblmidrule 
\cAlignHack Normal  &
  \cAlignHack 90-119  &
  \cAlignHack 60-79 \\
\cAlignHack Pre-hypertension  &
  \cAlignHack 120-139  &
  \cAlignHack 80-89 \\
\cAlignHack Stage 1 hypertension  &
  \cAlignHack 140-159  &
  \cAlignHack 90-99 \\
\cAlignHack Stage 2 hypertension  &
  \cAlignHack {\textgreater}160  &
  \cAlignHack {\textgreater}100 \\
\cAlignHack Isolated systolic hypertension  &
  \cAlignHack {\textgreater}/=140  &
  \cAlignHack {\textless}90 \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
If your blood pressure is over 180/120 mmHg, you could be experiencing a hypertensive emergency (extreme blood pressure elevation with acute or progressive target organ injury). Pathophysiologically, there are two major categories for hypertension:


  
  \begin{enumerate}
  \item \relax Essential or primary hypertension, where there is no recognized reason for the blood pressure to increase.
  \item \relax Secondary hypertension, where the increase is brought on by a condition affecting the kidneys, such as chronic diffuse glomerulonephritis or pyelonephritis; a vascular condition, such as renal artery disease; or an endocrine condition, such as phaechromocytoma, Cushing's syndrome, or primary aldosteronism. Clinically speaking, there are three phases of hypertension: mild, moderate, and severe. Mild hypertension is defined as having a diastolic blood pressure between 90 and 104 mm Hg, moderate hypertension between 105 and 114 mm Hg, and severe hypertension over 115 mm Hg. The person having systolic blood pressure more than 160 mm Hg with low diastolic blood pressure is termed as `Isolated Systolic Hypertension' commonly seen in elderly person. 
  \end{enumerate}
  \textbf{Aim}

To evaluate the use of anti-hypertensives in Cardiology patients having hypertension who admitted in the ICU department of a tertiary care hospital.

\textbf{Objectives }
  
  \begin{enumerate}
  \item \relax To study the drug utilization review of anti-hypertensives. 
  \item \relax To assess the drug prescribing patterns of anti-hypertensives. 
  \item \relax To study the clinical presentations and co-morbid illness.
  \end{enumerate}
  
    
\section{METHODOLOGY}
\textbf{Study Design}

Cross-sectional, Observational Study.

\textbf{Study Site}

Yashoda Multispeciality Hospital, Secunderabad.

\textbf{Study Duration}

6 months.

\textbf{Sample Size}

219 subjects.

\textbf{Study Data}

Patient data relevant to the study will be obtained from the case sheets in form of computerized patient profile forms.

\textbf{Study Criteria}

\textbf{Inclusion Criteria}


  
  \begin{enumerate}
  \item \relax All Cardiology in patients with age group of 20-85 years and above. 
  \item \relax Patients of both genders. 
  \item \relax Patients with comorbidities. 
  \item \relax Patients willing to cooperate and volunteering to give verbal communication. 
  \item \relax Patients receiving one or more antihypertensives.
  \end{enumerate}
  \textbf{Exclusion Criteria}


  
  \begin{enumerate}
  \item \relax Pediatric \& pregnancy patients.
  \item \relax Outpatients.
  \item \relax Patients not having hypertension. 
  \item \relax Patients not expected to cooperate or unconscious and comply with the treatment.
  \end{enumerate}
  \textbf{Plan of Study}
  
  \begin{enumerate}
  \item \relax All the hypertensive patients with the use of antihypertensive drugs data will be collected based on their age, gender, risk factors, and comorbidity condition. 
  \item \relax Patients who meet the above study criteria are enrolled into the study. 
  \item \relax All necessary information is collected from various sources. 
  \item \relax Patient's data that can be collected includes demographic details, Age, gender, address, weight, height, chief complaints, social history, family history, past medical history, past medication history and patient complications. 
  \item \relax Patient Case Sheet: General examination, vital signs, lab data (CBP, CUE, Serum electrolytes, thyroid profile), Current medication and final diagnosis, Lab parameters. 
  \item \relax The above data will be documented in the data collection form. 
  \item \relax By collecting the above data, the highly prescribed antihypertensive drugs will be assessed. 
  \item \relax Design of data collection form and past medication history form. 
  \item \relax Enrolling of patients based on inclusion and exclusion criteria. 
  \item \relax Identify antihypertensive medication administered to each patient. 
  \item \relax Assessing the utilization pattern of anti-hypertensives in general medicine department. 
  \item \relax Data including specific background information, demographic data, past medication history, patient medications, co-morbidities, and laboratory data were collected in patient data collection form. 
  \item \relax Find the most commonly prescribed antihypertensive drug group.
  \end{enumerate}
  
    
\section{RESULTS }
In the current study, 219 patients were included; age wise distribution \& Gender wise distribution were represented in Figure~\ref{f-e50a401d2bc5}  \& Figure~\ref{f-a001149ad9c2}  respectively. Figure~\ref{f-a001149ad9c2}  showed that males (68\%) are more affected with HTN than females (32\%). Figure~\ref{f-acfe3556a352}  reported that stage-2 HTN (48\%) is more common. Figure~\ref{f-a06f058908b0}  reported that T2DM is more common whereas Hypothyroidism is less common in Hypertensive patients. Figure~\ref{f-b7b83db0ce4e}  reported that monotherapy is more commonly given (53\%), whereas fixed drug combinations are less commonly given. Figure~\ref{f-55b0dcbc30b1}  reported that alpha+beta blockers are mostly prescribed and Angiotensin receptor blockers are less prescribed. Figure~\ref{f-4ac25b3c9e51}  reported that Carvedilol is more commonly prescribed drug and Metoprolol is less commonly prescribed drug.


\bgroup
\fixFloatSize{images/dc766696-c257-44e5-aa2d-e4891b1d42bc-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/dc766696-c257-44e5-aa2d-e4891b1d42bc-upicture1.png}{\includegraphics{images/dc766696-c257-44e5-aa2d-e4891b1d42bc-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Age Wise Distribution}}
\label{f-e50a401d2bc5}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/4055de1e-01e6-4a03-95cc-09d2546a5ff6-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/4055de1e-01e6-4a03-95cc-09d2546a5ff6-upicture2.png}{\includegraphics{images/4055de1e-01e6-4a03-95cc-09d2546a5ff6-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Gender Wise Distribution}}
\label{f-a001149ad9c2}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/f444b61d-e1cf-4978-907f-79b483a7988e-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/f444b61d-e1cf-4978-907f-79b483a7988e-upicture3.png}{\includegraphics{images/f444b61d-e1cf-4978-907f-79b483a7988e-upicture3.png}}{}
\makeatother 
\caption{\boldmath {Stage of HTN}}
\label{f-acfe3556a352}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/3fa2125b-62aa-436a-958c-6c15dc3c3345-upicture4.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/3fa2125b-62aa-436a-958c-6c15dc3c3345-upicture4.png}{\includegraphics{images/3fa2125b-62aa-436a-958c-6c15dc3c3345-upicture4.png}}{}
\makeatother 
\caption{\boldmath {Co-Morbidities}}
\label{f-a06f058908b0}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/7638d9d3-8bbc-4471-9373-4834a635a863-upicture5.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/7638d9d3-8bbc-4471-9373-4834a635a863-upicture5.png}{\includegraphics{images/7638d9d3-8bbc-4471-9373-4834a635a863-upicture5.png}}{}
\makeatother 
\caption{\boldmath {Type of Therapy}}
\label{f-b7b83db0ce4e}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/d4b8e556-1402-4817-87af-81892b1a80e7-upicture6.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/d4b8e556-1402-4817-87af-81892b1a80e7-upicture6.png}{\includegraphics{images/d4b8e556-1402-4817-87af-81892b1a80e7-upicture6.png}}{}
\makeatother 
\caption{\boldmath {Class of Drugs}}
\label{f-55b0dcbc30b1}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/5bd9c35f-a2cb-4151-86b1-a1f84e7c7d9b-upicture7.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/5bd9c35f-a2cb-4151-86b1-a1f84e7c7d9b-upicture7.png}{\includegraphics{images/5bd9c35f-a2cb-4151-86b1-a1f84e7c7d9b-upicture7.png}}{}
\makeatother 
\caption{\boldmath {Drugs Prescribed}}
\label{f-4ac25b3c9e51}
\end{figure}
\egroup

    
\section{DISCUSSION  }
The study was carried out with the participation of the in-patients at the General Medicine and Cardiology Department. The study included patients with essential hypertension, whether they also had co-morbid conditions or not. Analysis was done on the frequency and percentage of fixed drug combinations (FDCs) and monotherapy or combination treatment prescriptions for various antihypertensive medication groups. The study comprised 219 hypertension individuals in total. In-patient case sheets and direct interviews with patients and their observers provided the source of the patient data. 32\% of the patients were female, while 68\% of the patients were male, and the majority of the patients had stage-II hypertension. According to the study, a significant number of hypertension individuals also had diabetes mellitus. Alpha+beta blockers were the most often given class of antihypertensive medications, followed by calcium channel blockers and diuretics. Regarding patient therapy, 27.0\% of patients were given monotherapy, while 53.0\% were given combination therapy, of which 20\% were given FDCs.
    
\section{CONCLUSION }
According to the study, a large percentage of male hypertension patients also have co-morbid diabetes mellitus. Alpha+beta blockers were the most often given class of antihypertensive medications, followed by calcium channel blockers and diuretics. Regarding patient therapy, 27.0\% of patients were given monotherapy, while 53.0\% were given combination therapy, of which 20\% were given FDCs. The study concludes that clinical pharmacists can play a significant role in fostering rational prescription and enhancing medication adherence. The frequency and proportion of prescribing different groups of antihypertensive drugs as monotherapy or combination therapy, as well as prescription of fixed drug combinations (FDCs), were analyzed.
    
\section{ACKNOWLEDGEMENT}
We consider it as a great honour to express our deepest gratitude to Mr. Muttamsetty Krishna Rao, Chairman of Nova Group of Institutions, Dr. Jeevan Mani Babu, Principal of Nova College of pharmaceutical and research for providing adequate facilities without which this work would not have attained this standard. We sincerely extend our thanks to the staff of Nova College of Pharmaceutical Education and Research for their help during our work. At last, we acknowledge our dearest Parents and Family members for their constant moral support and motivation throughout our life.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.
    
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