Antihypertensive prescribing preferences in three South Indian Hospitals: cost analysis, physicians perspectives and emerging trends.

Objectives: The objectives of this study were i) to analyze the prescription pattern of antihypertensive agents in three South Indian hospitals ii) to perform cost-analysis of various antihypertensive treatment regimens iii) to examine the physicians' perspectives of antihypertensive prescribing.

Methods: A cross-sectional study was done on patients with essential hypertension (n = 2,100) by analyzing the medical records of the patients for the drugs prescribed and patient demographics. Cost comparisons were made for the most frequently prescribed agents for each class at the most frequently prescribed dose and regimen. A questionnaire was developed containing questions on familiarity with guidelines, diagnosis of clinical hypertension, an evaluation of patients and choice of drug, and was distributed to physicians in the three hospitals.

Results: About one-half of the patients received monotherapy where the remaining received combination therapy for their hypertension. Calcium channel blockers (CCBs) were the most preferred agents used, either as monotherapy or combination therapy in hypertensive patients with or without comorbidities. At the most frequently prescribed dose and dosage regimen, thiazide was the least expensive antihypertensives, followed by CCBs. Physician's responses favored the use of CCBs as first-line agent for uncontrolled hypertension and a two-drug combination approach.

Conclusions: The preference of CCBs and combination-therapy over the traditionally used diuretics or beta-blockers is consistent with the outcomes of recent clinical trials that underscore the benefits of using combination therapy with CCBs as initial therapy for uncomplicated hypertension.