Antihypertensive Prescribing Patterns and Drug-Related Problems Among Hospitalised Patients with Hypertension at a Tertiary Care Hospital in Peshawar, Pakistan: A Cross-Sectional Study

Abstract

Background: Hypertension is the leading modifiable cause of cardiovascular death, and its burden is rising fastest in low- and middle-income countries such as Pakistan. In hospitalised patients with multiple comorbidities, antihypertensive polypharmacy increases the risk of drug-related problems (DRPs), yet local data from tertiary care settings in Khyber Pakhtunkhwa are scarce. Objective: To describe the demographic and clinical profile, antihypertensive prescribing pattern, comorbidity burden and drug-related problems among patients admitted with hypertension to a tertiary care hospital in Peshawar. Methods: A single-centre, cross-sectional study was conducted over a 45-day period at Lady Reading Hospital, Peshawar. Fifty consecutively admitted patients aged 30–90 years with a diagnosis of hypertension were enrolled using a pre-designed data-collection proforma. Demographic data, prescribed medicines, comorbidities and DRPs (potential drug–drug interactions, adverse drug reactions and dosing errors) were recorded and analysed descriptively; proportions are reported with 95% confidence intervals (CIs). Results: The cohort was predominantly female (32/50; 64%, 95% CI 50.1–75.9) and middle-aged to elderly, with the largest group aged 51–60 years (26%). Most patients (31/50; 62%, 95% CI 48.2–74.1) were referred from districts outside Peshawar. The most frequently prescribed cardiovascular medicines were furosemide (74%), aspirin (60%), clopidogrel (60%), ramipril (48%), amlodipine (42%) and nifedipine (36%). Diabetes mellitus (20%), heart failure (15%) and chronic kidney disease (15%) were the commonest comorbidities. At least one potential drug–drug interaction was identified in 8 patients (16%, 95% CI 8.3–28.5), an adverse drug reaction in 5 (10%, 95% CI 4.3–21.4) and a dosing error in 3 (6%, 95% CI 2.1–16.2). Recurrent interacting pairs included renin–angiotensin blockers with calcium-channel blockers, clopidogrel with omeprazole, aspirin or non-steroidal anti-inflammatory drugs with furosemide, and antiplatelet with anticoagulant combinations. Conclusion: Antihypertensive prescribing in this tertiary care cohort was frequently guideline-discordant and accompanied by a substantial burden of preventable drug-related problems. Integration of clinical pharmacists into ward teams and routine interaction screening may improve prescribing quality and patient safety.

Keywords: Hypertension; Antihypertensive Agents; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Inappropriate Prescribing; Pharmacists; Pakistan.