A STUDY ON ANTI HYPERTENSIVE PRESCRIBING PATTERNS AND BLOOD PRESSURE MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE

INTRODUCTION: Systemic arterial hypertension also referred to as hypertension is characterized by persistently high blood pressure (BP) in the systemic arteries. BP is commonly expressed as the ratio of the systolic BP that is, the pressure that the blood exerts on the arterial walls when the heart contracts and the diastolic BP the pressure when the heart relaxes usual limit is 120/80mmHg. Hypertension is widely prevalent in India with large regional variation, greater prevalence in urban areas treatment and control status are low. Hypertension was more in men than women. Hypertension is more common in developed countries, urban population and better socio- economic status individuals. The introduction of a formal definition for CKD has enabled standardize current medical communication facilitate appropriate population. Encourage timely prevention and treatment of kidney disease through screening. The GFR is considered the most reliable indicator of overall kidney function. GFR level below 60 mL / minute / 1.73 m2 represents loss of one half or more of the adult level of normal kidney function. Normal GFR varies according to patient age, sex, and body size. The MDRD formula is a better estimate of GFR than those derived from 24-hr urine clearance or the Cockcroft- Gault formula. The abbreviated MDRD formula requires gender, race, and serum creatinine. AIM: The study aims to mainly Aim to assess the selection of Antihypertensive Drugs in single and combination therapy in patients with chronic kidney disease. OBJECTIVE: The main objective is to study the prescription patterns of Antihypertensive drugs in patients with chronic kidney disease. METHODOLOGY: This study is a prospective observational study and the subjects involved in the study are Inpatients in Nephrology department at Government general Hospital, Kurnool. The subjects are selected on the basis of the inclusion and exclusion criteria. RESULTS & DISCUSSION: This study involved 120 CKD patients with hypertension to assess the prescription pattern of anti-hypertensive drugs. In our study, 58% males and 42% females were taken. In the present study most of the patients were given dual therapy (43%) followed by triple therapy (33%), this result is supported with the study by Ashok Kumar malapani et.al., that portrayed dual therapy in (78%) of prescription. Individuals with resistant hypertension will require more than or equal to three drugs out of which one is diuretic. Patients must be approached in a step wise manner beginning with traditional anti-hypertensive therapy followed by additional agents to reach a triple or quadruple or five drug compound regimens. Resistant hypertension is defined as blood pressure that remains above 140/90 mm Hg despite optimal use of three anti-hypertensive medications of different classes, including a diuretic. In the present study diuretics and calcium channel blockers are most preferred class of drugs that is used 31% each, which is supported with the study by Alwin P Saju et.al. Among monotherapy calcium channel blockers were most prescribed drug. In dual therapy Calcium channel blockers and Diuretics, in triple therapy diuretics, Calcium channel blockers, Beta blockers and in multiple therapy Diuretics, Beta blockers, Calcium channel blockers, Central sympatholytics are more frequently prescribed. Among Diuretics, furosemide is the most preferred drug, in Angiotensin receptor blockers, telmisartan. In Beta - blockers, metoprolol, in Alpha and Beta blockers, Labetalol, in Central sympatholytic, Clonidine and in Calcium channel blockers amlodipine f/b nifedipine and cilnidipine are more frequently prescribed. CONCLUSION: Our study concludes that males are more prone to Chronic kidney disease, Based on Age wise distribution 41-50 years, 51-60 years patients were hospitalized more frequently. Most of the patients were prescribed with Dual Therapy and Triple Therapy as most of the patients develops Resistant Hypertension. In Mono Therapy, Calcium channel blockers were more prescribed. Among all Anti-Hypertensives, Calcium channel blockers and Diuretics are most prescribed. KEYWORDS: Resistant hypertension, Chronic Kidney Disease, Modification of diet in Renal Disease (MDRD), Glomerular Filtration Rate.