Assessment of antihypertensive drug use among hypertensive patients presented with acute coronary syndrome

Background: Aggressive blood pressure (BP) control is essential for secondary prevention in hypertensive, particularly diabetic-hypertensive, patients with established cardiovascular disease (CVD).

Objectives:  To assess current prescription scenario of antihypertensive medications among diabetic and non-diabetic hypertensive patients presented with acute coronary syndrome (ACS).

Methods:  This was a cross-sectional observational study conducted at The Heart Care Clinic, Ahmedabad (INDIA), from August 2007 to January 2008, among patients presented with ACS. The data, including demographic information, vital signs, personal particulars, details of risk factors for ACS and medications prescribed at discharge, was analyzed.

Results: Of 369 patients (81.84% male), 208 (56.34%) were found to be hypertensive. Prevalence of diabetes among hypertensive patients was 37.02%. The most of the hypertensive patients were prescribed multiple antihypertensive agents (polytherapy) irrespective of presence of diabetes (monotherapy 10.39% and 15.27%; and polytherapy 89.61% and 84.73%, from diabetic and non-diabetic hypertensive patients, respectively, p=0.3197). Among patients on polytherapy, proportion of patients on combination of three antihypertensive drugs was significantly higher among diabetic hypertensive patients (44.93% vs. 19.82%, p=0.0003). Except for diuretics and calcium channel blockers (CCBs), there was no difference in proportion of patients receiving various antihypertensive agents from different classes in diabetic and non-diabetic hypertensive patients. From diabetic-hypertensive patients, significantly higher proportion of patients were on diuretics and CCBs (for diuretics: 24.43% vs. 46.75%, p=0.0009; for CCBs: 25.97% vs.9.92%, p=0.0022).

Conclusions:  Typically diabetes is more prevalent in hypertensive ACS patients from India. Combination therapy is preferred over monotherapy to treat hypertension in both diabetic as well as non diabetic patients with CAD. Current prescribing for antihypertensive drug classes is fairly consistent with current recommendations adhering evidence-based practice. Apparently, more frequent use of combination of three antihypertensive drugs among diabetic-hypertensive patients reflects efforts for aggressive BP control in this sub-group of patients to meet stricter targets for BP.