A cross-sectional assessment of rational use of antihypertensive medications in central Kayseri

Abstract

Aim: To evaluate prescriptions issued for patients diagnosed with hypertension in terms of rational drug use and cost-effectiveness.

Methods: This retrospective observational study was conducted using prescriptions issued for patients diagnosed with essential hypertension in the central district of Kayseri, Turkey. Data were obtained from the Medulla Provision System, encompassing prescriptions that included at least one antihypertensive drug and were covered by national health insurance during January 2019. Prescriptions were evaluated based on patient demographics (age and sex), prescribed antihypertensive drugs (pharmacological group and active ingredient), physician specialty, and healthcare institution, presence of comorbidities at treatment initiation and follow-up, and conformity of the chronic disease report to clinical guidelines.

Results: The study included 1,968 prescriptions, with a mean patient age of 63.97 ± 11.88 years. Rational drug use (RDU) was significantly higher in the 18–64 age group (81.6%) compared to those aged ≥80 years (88.9%) (χ² = 6.123, p = 0.039), and among males (84.8%) versus females (80.8%) (χ² = 5.123, p = 0.024). Prescriptions from general practitioners showed significantly lower RDU rates compared to those from cardiologists and internists. RDU was observed in 83.6% of patients without asthma using beta-blockers, while only 21.1% of asthmatic patients on beta-blockers met RDU criteria (χ² = 43.089, p < 0.001). Prescriptions with three active ingredients had the lowest RDU rate (70.9%), compared to those with one (85.0%) or two (88.3%) ingredients (χ² = 70.976, p < 0.001). The median treatment cost was significantly lower in the RDU group (10.72 USD) than in the non-RDU group (11.76 USD) (z = 4.076, p < 0.001). Although not statistically significant (p = 0.081), the highest RDU rate was observed in prescriptions containing generic imported drugs (26.0%). Cost analysis showed that original imported drugs had the highest unit cost (2.85 USD), while generic imported drugs had the lowest (1.90 USD) (p < 0.001).

Conclusion: This study demonstrated that adherence to rational drug use principles in the treatment of hypertension, aligned with current clinical guidelines, results in safer and more cost-effective therapeutic outcomes. Rational prescribing was associated with lower drug counts per prescription and reduced treatment expenditures. However, the widespread use of beta-blockers, particularly outside of their recommended indications, and the preference for original branded products indicate areas for improvement. To enhance rational prescribing practices, awareness must be increased at all levels of the healthcare system, and policy-driven targets should be developed accordingly.