title: Antihypertensive drugs for elderly patients: a cross- sectional study.
abstract: BACKGROUND
  As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient's first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings.
  
  
  METHODS
  Data on patient demographics, diagnosis, prescription pattern, payment mode and follow-up was extracted from a cross-sectional study involving 122 public primary care clinics and 652 private primary care clinics in Malaysia. Encounters with hypertensive patients aged ≥ 60 years were included.
  
  
  RESULTS
  A total of 1,017 antihypertensive medications were prescribed - calcium channel blockers (27.1%), beta blockers (25.5%), diuretics (23.3%), angiotensin-converting enzyme inhibitors (14.9%) and angiotensin receptor blockers (6.3%). Out of the 614 patient encounters, 53.1% of the patients were prescribed monotherapy, 31.6% were prescribed dual therapy, 12.2% triple therapy, 2.8% quadruple therapy and 0.3% quintuple therapy. Type of primary care clinic and payment mode were significant predictors for the prescription of combination therapy and fixed-dose combination therapy, respectively. Four types of inappropriate prescriptions were identified.
  
  
  CONCLUSIONS
  Calcium channel blockers were the most common antihypertensive drug prescribed and more than half of the elderly patients were on monotherapy. Antihypertensive drug prescription was found to be associated with the type of primary care clinic and the payment mode, suggesting that prescription is influenced by the cost of the drug.
authors.affiliation: Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Ka Keat
authors.initials: KK
authors.lastname: Lim
authors.affiliation: Healthcare Statistics Unit, Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Sheamini
authors.initials: S
authors.lastname: Sivasampu
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ee Ming
authors.initials: EM
authors.lastname: Khoo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003153:Community Health Services; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D057970:Inappropriate Prescribing; D016015:Logistic Models; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D017149:Private Sector
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
keywords: Malaysia; aged; antihypertensive drugs; prescriptions; primary care