Evaluation of Prescribing Pattern and Adverse Drug Reactions of Antihypertensive Drugs in a Tertiary Care Teaching Hospital: A Prospective Observational Study

Hypertension is a major public health challenge affecting millions worldwide. It significantly contributes to ischemic heart disease, stroke, heart failure, chronic kidney disease, and premature mortality. Effective blood pressure control substantially reduces cardiovascular complications.

Several classes of antihypertensive drugs are available, including calcium channel blockers (CCBs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta blockers, diuretics, alpha blockers, and centrally acting agents. Selection of therapy depends on age, comorbidities, severity of hypertension, tolerability, and evidence-based guidelines.

 Irrational prescribing, underuse of combination therapy when needed, poor adherence, and inadequate monitoring may compromise treatment outcomes. In addition, antihypertensive drugs may produce ADRs such as cough, dizziness, edema, fatigue, electrolyte disturbances, and bradycardia.

Drug utilization studies are important tools to evaluate current prescribing practices and promote rational therapy. Therefore, the present study was conducted to assess the prescription pattern of antihypertensive drugs and associated ADRs in a tertiary care teaching hospital.

Study Design

Prospective observational study.

Study Setting

Department of Pharmacology in collaboration with Department of General Medicine of a tertiary care teaching hospital.

Study Duration

12 months.

Study Population

Patients diagnosed with hypertension and receiving antihypertensive medications.

Sample Size

350 patients.

Inclusion Criteria

·        Patients aged ≥18 years.

·        Diagnosed hypertension patients on treatment.

·        Willing to provide informed consent.

 Exclusion Criteria

·        Pregnant women with gestational hypertension.

·        Critically ill patients.

·        Incomplete prescription records.

 Data Collection

The following details were recorded:

·        Age and gender

·        Duration of hypertension

·        Blood pressure status

·        Drug class prescribed

·        Monotherapy or combination therapy

·        Dose and frequency

·        Concomitant diseases

·        Reported ADRs

 ADR Assessment

Causality assessment was done using WHO-UMC scale.

 Statistical Analysis

Data were analyzed using Microsoft Excel and SPSS. Results expressed as mean ± SD, frequencies, and percentages.

 Ethical Approval

Approved by Institutional Ethics Committee.

Demographic Profile

A total of 350 patients were included. Males were 204 (58.3%) and females were 146 (41.7%). Mean age was 54.6 ± 12.8 years.

Mean age = 54.6 ± 12.8 years

Pattern of Antihypertensive Drug Use

Calcium channel blockers were the most commonly prescribed class.

 Therapy Pattern

Combination therapy was more common than monotherapy.

Commonly Used Combinations

Adverse Drug Reactions

ADRs were observed in 61 patients (17.4%).

 Severity of ADRs

The present study found that calcium channel blockers were the most commonly prescribed antihypertensive agents, followed by ARBs. This pattern may be due to better tolerability, once-daily dosing, and suitability in elderly patients.

Combination therapy was prescribed in more than half of the patients, indicating the need for multiple agents for adequate blood pressure control. ARB + diuretic was the most common combination, consistent with guideline recommendations.

ADRs were reported in 17.4% patients. Pedal edema was the most common ADR, likely associated with calcium channel blockers. Dry cough was commonly seen with ACE inhibitors. Most ADRs were mild to moderate and manageable with dose adjustment or substitution.

These findings emphasize the importance of individualized treatment and regular monitoring. 

Limitations

1. Single-center study.
2. Moderate sample size.
3. Long-term adherence not assessed.
4. BP outcome analysis not included.

Calcium channel blockers and ARBs were the most commonly prescribed antihypertensive drugs. Combination therapy was frequently used for better BP control. ADRs were mostly mild and manageable. Rational prescribing and active pharmacovigilance are essential for optimal hypertension management.

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