Anti-Hypertensive Prescription and Cost Patterns in an Outpatient Department of a Teaching Hospital in Lagos State Nigeria

Akin Osibogun, Tochi Joy Okwor

Department of Community Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.

DOI: 10.4236/ojpm.2014.44021                

Abstract

Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are; diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.

Keywords

Hypertension; Prescription Patterns; Co-Morbidity; Cost; Nigeria

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kearny, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K. and He, J. (2005) Global Burden of Hypertension: Analysis of Worldwide Data. Lancet, 365, 217-223. http://dx.doi.org/10.1016/S0140-6736(05)17741-1
[2]	World Health Organization (2013) A Global Brief on Hypertension; Silent Killer, Global Public Health Crisis. World Health Organization, Geneva.
[3]	Ekwunife, O.I., Udeogaranya, P.O. and Nwatu, I.L. (2010) Prevalence, Awareness, Treatment and Control of Hypertension in a Nigerian population. Health, 2, 731-735. http://dx.doi.org/10.4236/health.2010.27111
[4]	Erhun, W.O., Olayiwola, G., Agbani, E.O. and Omotosho, N.S. (2005) Prevalence of Hypertension in a University Community in South West Nigeria. African Journal of Microbiology Research, 8, 15-19.
[5]	Neal, B., MacMahon, S. and Chapman, N. (2000) The Blood Pressure Lowering Treatment Trialists Collaboration. Effects of ACE Inhibitors, Calcium Antagonists, and Other Blood-Pressure-Lowering Drugs: Results of Prospectively designed Overview of Randomized Trials. Lancet, 355, 1955-1964.
[6]	Amira, C.O. and Okubadejo, N.U. (2006) Antihypertensive Pharmacotherapy in a Developing Economy: Pattern, Acquisition Costs and Conformity to International Guidelines in a Tertiary-Care Setting. Journal of Human Hypertension, 20, 894-897. http://dx.doi.org/10.1038/sj.jhh.1002080
[7]	Zheng, B., Poulose, A.F. and Holbrook, A. (2012) A Pilot Study on Cost-Related Medication Non Adherence in Ontario. Journal of Population Therapeutics and Clinical Pharmacology, 19, 239-47.
[8]	Ilesanmi, O.S., Ige, O.K. and Adebiyi, A.O. (2012) The Managed Hypertensive: The Cost of Blood Pressure Control in a Nigerian Town. The Pan African Medical Journal, 12, 96.
[9]	Obikeze, O.O., Ige, O.K., Osungbade, K.O., Olumide, E.A. and Asuzu, M.C. (2010) An Overview of the National Health Insurance Scheme in Nigeria. Dokita, 1, 15-21.
[10]	Liu, P.-H. and Wang, J.-D. (2008) Antihypertensive Medication Prescription Patterns and Time Trends for Newly Diagnosed Uncomplicated Hypertension Patients in Taiwan. BMC Health Services Research, 8.
[11]	US Department of Health and Human Services, National Institutes of Health, National Heart LaBI (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. NIH Report No. 03-5233.
[12]	Hall, S.H. (2006) A User’s Guide to Selecting a Comorbidity Index for Clinical Research. Journal of Clinical Epidemiology, 59, 849-855. http://dx.doi.org/10.1016/j.jclinepi.2005.11.013
[13]	Hogerzeil, H.V., Ross-Degnam, D., Laing, R.O., Ofori, A., Santoso, B., Azad, C.A.K., et al. (1993) Field Tests for Rational Drug Use in Developing Countries. Lancet, 324, 1408-1410. http://dx.doi.org/10.1016/0140-6736(93)92760-Q
[14]	Adebisi, S.A., Oghagbon, E.K. and Jimoh, A.K. (2003) Glycated Haemoglobin and Associated Variables in Diabetics: Ilorin Experience. West African Journal of Medicine, 22, 318-320.
[15]	Odili, V.U., Oghagbon, E.K., Ugwa, N.A., Ochei, U.M. and Aghomo, O.E. (2008) Adherence to International Guidelines in the Management of Hypertension in a Tertiary Hospital in Nigeria. Tropical Journal of Phatmaceutical Research, 7, 945-952. http://dx.doi.org/10.4314/tjpr.v7i2.14608
[16]	Ma, J., Lee, K. and Stafford, R.S. (2006) Changes in Antihypertensive Prescribing during US Outpatient Visits for Uncomplicated Hypertension between 1993 and 2004. Hypertension, 48, 846-852. http://dx.doi.org/10.1161/01.HYP.0000240931.90917.0c
[17]	Adigun, A.Q., Ishola, D.A., Akintomide, A.O. and Ajayi, A.A. (2003) Shifting Trends in the Pharmacological Treatment of Hypertension in a Nigerian Tertiary Hospital: A Real World Evaluation of the Efficacy, Safety, Rationality and Pharmacoeconomics of Old and New Antihypertensive Drugs. Journal of Human Hypertension, 17, 277-285. http://dx.doi.org/10.1038/sj.jhh.1001538