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Varakantham et al
suitable to the given population, thereby rationalizing the
prescription pattern. Furthermore, the prescription data in
relation to dynamic activities are barely available to propagate among the physicians. Therefore, the decision is independent most of the time and is influenced by the information
provided by the medical representatives.31 The socioeconomic profile also plays a crucial role in a country like ours
where prescription pattern is dependent.32
In contrast to the suggested use of combination therapy
in various hypertension management guidelines, be it JNC
7 or 8, here we notice that the monotherapy was used
profoundly33; this can be probably attributed to the presence of rather naive hypertensive patients who have
recently been diagnosed with high BP. In addition, the
fixed drug combinations were not found to be available in
the government hospital as they were not quoted in the
NLEM list. Although evidence-based studies have found
that combination therapy leads to better BP reduction with
low-dose combinations, very few studies have adopted it,
such as Nigerian study25 with 97.5% use of combinations
and 56.1% in a south Indian study.34
The usage of generic names and NLEM compliance are
among the different ways to measure the rational drug utilization pattern in the prescription profiles. In our study, prescriptions of the 2012 were found to be more close to these indicators
when compared with the calendar year 2014. In another study
conducted in India, 65% of adherence to NLEM was noted.35
Even though the adherence shown in 2012 is more than in
2014, it is always the clinicians' discretion that plays a pivotal
role in the prescription of the medicines. Furthermore, the
results of various studies have shown that adherence to clinical
guidelines are not homogeneous; in fact, they have been found
to vary with time and region, and patient characteristics and
physicians' discretion play a huge role. Therefore, a deviation
from the recommendations may always be expected.

Conclusion
In conclusion, our study has revealed that JNC 8 guidelines
were followed closely by the clinicians of the tertiary care
government hospital. The physicians were up-to-date with
the new hypertension guidelines. It was also observed that
change in the first choice of antihypertensive therapy is significantly different in both the calendar years of 2012 (BB)
and 2014 (ACEI). A regular monitoring of the prescription
pattern is essential to keep a tab on the rational drug prescriptions for a better therapeutic outcome.
Acknowledgments
The authors are grateful to the Department of Science & Technology
(DST) for according Inspire fellowship to Ms. Varsha Varakantham.
The authors are thankful to Director in-Charge of the National
Institute of Nutrition (Indian Council of Medical Research) for their
support.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplementary Material
The supplements for the article are available online.

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https://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf https://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf http://pharmaceuticals.gov.in/pdf/NLEM.pdf http://pharmaceuticals.gov.in/pdf/NLEM.pdf http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=71533650&site=ehost-live http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=71533650&site=ehost-live http://www.ijopp.org/sites/default/files/IJOPP_v2_i2_2009_12.pdf http://www.ijopp.org/sites/default/files/IJOPP_v2_i2_2009_12.pdf http://www.saspublisher.com

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