Hospital Pharmacy - April 2018 - 107

738080
research-article2017

HPXXXX10.1177/0018578717738080Hospital PharmacyVarakantham et al

Article

Antihypertensive Prescription Pattern
and Compliance to JNC 7 and JNC 8 at
Tertiary Care Government Hospital,
Hyderabad, India: A Cross-sectional
Retrospective Study

Hospital Pharmacy
2018, Vol. 53(2) 107-112
© The Author(s) 2017
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https://doi.org/10.1177/0018578717738080
DOI: 10.1177/0018578717738080
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Varsha Varakantham1, Ashok Kumar Kurakula Sailoo2,
and Dinesh Kumar Bharatraj1

Abstract
Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective
of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance
with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results:
A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of
drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin
receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014,
the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics (P < .001). Most notably, there was
a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the
first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be
the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs
11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar
year 2012 than in the calendar year 2014 (P < .001). Conclusions: Antihypertensive medication use has gone through
wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the
guidelines for achievement of blood pressure goals.
Keywords
antihypertensive drugs, adherence, prescription pattern, JNC 7, JNC 8, India

Introduction
High blood pressure (BP) is a major public health issue in India
and is rampant among both urban and rural populations.1 It is
the key modifiable risk factor for many diseases. Although lifestyle modification is important in hypertension management,
most hypertensive individuals require ≥2 antihypertensive
drugs to reduce their BP and maintain it. In 2003, the National
High Blood Pressure Education Program Coordinating
Committee published the Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 7).2 These guidelines recommended angiotensin-converting enzyme inhibitors (ACEI),
angiotensin receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), or thiazide-type diuretic classes
as initial therapy but recommended thiazide-type diuretics as
initial therapy for most patients without compelling indication

for another class, and the use of ≥2 antihypertensive agents from
different drug classes to achieve the goal of BP control (BP of
<130/80 mm Hg for patients with diabetes mellitus or chronic
kidney disease; and a BP of <140/90 mm Hg for all other hypertensive people). While in 2014, Eighth Joint National Committee
(JNC 8) was formulated.3 These guidelines in contrast to the
JNC 7 have now set the same preference to the drugs except for
BB. The goal BP were revised to <150/90 mm Hg for age ≥60
years while <140/90 mm Hg for hypertensive adults with
1

National Institute of Nutrition, Hyderabad, Telangana, India
Gandhi Hospital, Secunderabad, Telangana, India

2

Corresponding Author:
Dinesh Kumar Bharatraj, Food and Drug Toxicology Research Centre,
National Institute of Nutrition, Indian Council of Medical Research,
Tarnaka, Hyderabad, Telangana 500007, India.
Email: nindineshpct@gmail.com
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