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Statins in Patients with Uncomplicated Hypertension: A Prescription Audit
Krishna Kumar Sharma1, Vishnu Natani2, Nishant Gupta3
1Department of Pharmacognosy, LBS College of Pharmacy, Jaipur, Rajasthan.
Insights
Guidelines recommend statins for high-risk hypertension patients. However, an Indian audit found only half of moderate-to-high risk patients received statin prescriptions, indicating a gap in care.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Pharmacology
Background:
- Current guidelines advocate for statin prescription in all high-risk hypertensive patients, regardless of cholesterol levels.
- Hypertension is a significant global health concern, often coexisting with other cardiovascular risk factors.
Purpose of the Study:
- To audit statin prescription practices among hypertensive patients in India.
- To assess the adherence to international guidelines for statin use in this population.
Main Methods:
- A registry-based audit of 3073 patients diagnosed with hypertension was conducted.
- Patients were categorized by risk using a multivariate model, and statin intensity was classified per US guidelines.
- Exclusion criteria included patients with pre-existing vascular disease.
Main Results:
- Statin prescriptions were issued to 41.2% of patients, with higher rates in men and increasing prevalence with age and risk level.
- Moderate-intensity statins were most commonly prescribed (83.9%).
- Prescription rates were higher in patients with diabetes (52.0%), obesity (60.9%), and smoking (52.5%).
Conclusions:
- In Indian secondary care, approximately half of moderate-to-high risk hypertensive patients without vascular disease are prescribed statins.
- This suggests a potential underutilization of statins despite guideline recommendations.
Objective:
Guidelines recommend prescription of statins in all high-risk patients with hypertension irrespective of their cholesterol levels. We performed a prescription audit in India to determine the application of recommendations.
Methods:
A registry-based audit of patients with primary diagnosis of hypertension (n=3073) was performed. Details of co-morbidities and medications were obtained. Patients with known vascular disease were excluded. Patients were classified into subgroups based on risk factors and type of therapy. A multivariate model of risk was developed using clinical data and patients were classified into low, moderate and high risk. Statin prescriptions were divided into low, medium and high intensity based on US guidelines. Descriptive statistics are reported.
Results:
Mean age of patients was 59±13 years, 47 % were women and 26 % were less than 50 years age. Diabetes was noted in 31.1 %, current smoking in 1.3 %, obesity in 14.7 % and hypothyroidism in 7.9 %. Statins were prescribed in 41.2 % (95% CI 39.4-42.9%), more in men compared to women (47.7% vs 33.7%, p<0.001). Most of the patients received moderate intensity statins (83.9%). In age-groups >40, 40-59, 60-79 and 80+ years, statins were prescribed in 18.7%, 36.5%, 49.5% and 49.4% respectively (ptrend <0.001). Statins were prescribed in 52.0% diabetics, 60.9% obese, 52.5% smokers and 34.8% hypothyroid. In the multivariate model statins use in low, medium and high risk patients was 28.4%, 46.6% and 55.1% respectively (ptrend <0.001).
Conclusion:
In an Indian secondary care practice only half of patients with moderate to high risk uncomplicated hypertension receive statins.
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