Patterns of antihypertensive drugs’ use in community pharmacy; drug related problems and adherence to medication identified in a retrospective analysis of prescriptions

Abstract

Despite effective antihypertensive medication, arterial hypertension remains an important contributor to cardiovascular diseases, the main global cause of mortality. We performed a retrospective analysis of prescriptions containing antihypertensive drugs dispensed from two community pharmacies from Bucharest, Romania. In order to explore differences in prescriptions’ trends, we analysed drugs dispensed in 2007 and 2017, evaluating the frequencies of the drugs used in monotherapy or in poly-therapy and the conformity with treatment guidelines available at the moment, the drug related problems and patients’ adherence to medication, based on the superposition of drugs prescribed and those dispensed. We analysed 4635 prescriptions, from which 2332 were presenting at least HBP as diagnostic. 52.05% of the 2198 prescriptions from 2017 were for HBP, statistically significant compared to the 48.75% of the 2537 corresponding prescriptions from 2007. All the main antihypertensive drugs classes increased statistically significant in use from 2007 to 2017, except the angiotensin-converting enzyme inhibitors. Antihypertensive mono-therapy decreased from 27.8% in 2007 to 19.7% in 2017 (p < 0.0001), which was in line with the updated recommendations that favoured combination therapy as being more efficacious. As to the drug regimen complexity, 11.5% of the prescriptions from 2007 and 18.6% of the prescriptions from 2017 contained antihypertensive drugs prescribed in a different manner from the one indicated in their officially endorsed monographs. We also found that in 2007, 10.94% of hypertensive patients didn’t purchase all the medicines prescribed by the doctor, giving up part of their treatment. In 2017, the percentage of these non-adherent patients raised to 20.19%. We believe that pharmacist’s interventions, including suggestions for simplification of the drug regimen, can increase the levels of adherence to medication, thus improving hypertensive patients’ clinical outcomes.