Document Type : Original Article
Authors
Clinical Pharmacy Laboratory, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, Indonesia
Abstract
Objective: The treatment of hypertension requires special attention because of
comorbidities and polypharmacy. In a previous study, polypharmacy has been
associated with a high risk of drug-related problems (DRPs). This study aimed
to analyze DRPs in Indonesian hypertensive patients focusing on drug therapy
effectiveness and adverse drug reactions. Methods: A cross-sectional study was
conducted using medical records’ data, prescriptions, and nursing records to observe
DRPs that occurred in outpatients with hypertension from February to April 2019.
A total of 114 outpatients aged ≥23 years with a primary diagnosis of primary
hypertension were included in this study. DRPs were reviewed based on literature,
recent guidelines, and drug interaction software. Classification DRPs were done
using Indonesian-translated Pharmaceutical Care Network Europe V6.02. The data
obtained were analyzed using univariate descriptive analysis. Findings: Of all
participants, 65 (57%) outpatients were found to have DRPs related to treatment
effectiveness (54 cases) and adverse drug reactions (36 cases). The primary cause
of the problems was an inappropriate drug (94.14%) and dose selection (2.86%).
Potential drug interactions were found high (62.14%) in the combination of an
antihypertensive agent with other drugs among patients. Overprescribing drugs
without clear indications, untreated indications, and subtherapeutic dosage were
also reported in this study. Conclusion: A significant percentage of outpatients
being treated for hypertension experienced DRPs. The role of clinical pharmacists
and physicians in monitoring drug therapy needs to be prioritized to prevent and
resolve DRPs in outpatients with hypertension.
Keywords
Dennison HC, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/
APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention,
detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/
American Heart Association Task Force on Clinical Practice
Guidelines. Hypertension 2018;71:1269-324.
2. Kementerian Kesehatan Republik Indonesia. Hasil Utama
Riskesdas 2018. Jakarta: Kemenkes; 2018.
3. European Society of Cardiology. 2018 ESC/ESH Guidelines for
the Management of Arterial Hypertension The Task Force for the
Management of Arterial Hypertension of the European Society
of Cardiology (ESC) and the European Society of Hypertension;
2018. p. 1-98.
4. Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy
as commonly defined is an indicator of limited value in the
assessment of drug-related problems. Br J Clin Pharmacol
2007;63:187-95.
5. Hailu BY, Berhe DF, Gudina EK, Gidey K, Getachew M. Drug
related problems in admitted geriatric patients: The impact of
clinical pharmacist interventions. BMC Geriatr 2020;20:13.
6. Pharmaceutical Care Network Europe. Classification for drug
related problems v6.02. Pharmaceutical Care Network Europe
Foundation; 2010.
7. Griese-Mammen N, Hersberger KE, Messerli M, Leikola S,
Horvat N, van Mil JWF, et al. PCNE definition of medication
review: Reaching agreement. Int J Clin Pharm 2018;40:1199-208.
8. Hussein M, Lenjisa J, Woldu M, Tegegne G, Umeta G, Dins H.
Assessment of drug related problems among hypertensive
patients on follow up in Admaa Hospital Medical College, East
Ethiopia. Clin Pharmol Biopharm 2014;3:1-6.
9. Nasution A, Khairunnisa, Tanjung HR. Drug related problems in
management of hypertensive outpatients admitted to four Indonesian
primary health centers. Asian J Pharm Clin Res 2016;9:87-90.
10. Supraptia B, Nilamsari WP, Hapsari PP, Muzayana HA,
Firdausi H. Problems Related to Antihypertensive Drugs in
Elderly Patients at the Geriatric Clinic Dr. Soetomo Hospital,
Surabaya. Indones J Clin Pharm 2014;1:36-41.
11. Redzuan AM, Ramli AR, Pheng MT. Drug related problems in
hypertensive patients with multiple comorbidites. J Pharm Res
2017;1:1-8.
12. Lee SP, Bae JW, Park KW, Rha SW, Bae JH, Suh JW, et al.
Inhibitory interaction between calcium channel blocker and
clopidogrel. ‑Efficacy of cilostazol to overcome it‑. Circ J
2011;75:2581-9.
13. Inayah N, Manggau MA, Amran Y . Analysis of effectiveness
and side effects of using clopidogrel alone and in combination
clopidogrel-aspilet in ischemic stroke patients at the RSUP
Dr. Wahidin Sudirohusodo Makassar. Majalah Farmasi dan
Farmakologi 2018;22:81-4.
14. Puspitasari AW, Azizahwati A, Hidayat AR. Analysis of potential
drugs interaction on Antihypertensions drugs prescription in
community health center of Sukmajaya district in period of
June-November 2015. Asian J Pharm Clin Res 2017;10:61-5.
15. Bailey RR, Neale TJ. Rapid clonidine withdrawal with blood
pressure overshoot exaggerated by beta-blockade. Br Med J
1976;1:942-3.
16. Moore N, Pollack C, Butkerait P. Adverse drug reactions and
drug-drug interactions with over-the-counter NSAIDs. Ther Clin
Risk Manag 2015;11:1061-75.
17. Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization
of proton-pump inhibitors: What the clinician needs to know.
Therap Adv Gastroenterol 2012;5:219-32.
18. Maes ML, Fixen DR, Linnebur SA. Adverse effects of
proton-pump inhibitor use in older adults: A review of the
evidence. Ther Adv Drug Saf 2017;8:273-97.