Prescribing patterns and therapeutic implications for diabetic hypertension in Bahrain.
OBJECTIVE
To determine drug prescription patterns and the extent of conformity with World Health Organization/international Society of Hypertension (WHO/ISH) guidelines in diabetic hypertension.


METHODS
Retrospective prescription-based survey.


METHODS
Seven primary-care health centers, comprising approximately one-third of primary-care health centers in Bahrain.


METHODS
Patients with type 2 diabetes and hypertension.


METHODS
The prescribing pattern of antihypertensive and antidiabetic drugs.


RESULTS
Among a study sample of 1,463 patients with type 2 diabetes and hypertension, antidiabetic agents were prescribed as monotherapy in the following descending order: glyburide, gliclazide, insulin, and metformin. As combinations, sulfonylureas plus metformin was most popular, followed by metformin plus insulin, and sulfonylureas plus insulin. Sulfonylurea and metformin with insulin was rarely used. There was no significant difference in prescribing of glyburide and metformin between the elderly and young middle-aged diabetic patients; many patients older than 65 years were treated with a beta-blocker along with a long-acting sulfonylurea. Both as monotherapy and in overall use, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium-channel blockers were most often prescribed. Among 35.5% patients treated with antihypertensive combinations, various two- and three-drug combinations of beta-blockers, ACE inhibitors, calcium-channel blockers, and diuretics were often used. The proportion of patients taking atenolol 100 mg/d was higher with combination regimens. Hydrochlorothiazide 25 mg or equivalent thiazide diuretics were extensively used.


CONCLUSIONS
The prescribing pattern of antihypertensives in diabetic hypertension differs in many instances from WHO/ISH guidelines, especially regarding the choice of antihypertensive drugs and their combinations. The appropriateness of antidiabetic drug choice is questionable in relation to the antihypertensive used.
Al Khaja
K A
KA
Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain. Khlidj@agu.edu.bh.Bahrain
Sequeira
R P
RP
Mathur
V S
VS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001445:Bahrain; D001581:Benzothiadiazines; D048909:Diabetes Complications; D004232:Diuretics; D004338:Drug Combinations; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D012189:Retrospective Studies; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D007328:Insulin; D049993:Sodium Chloride Symporter Inhibitors