Hypertension has been identified as the leading global risk factor for mortality and considered as the third contributing factor of disease burden worldwide that makes it a major public health challenge (Rodgers et al., 2004). Elevated blood pressure accounts for two-thirds and one-half of all cases of stroke and ischemic heart disease respectively. Prevalence of chronic kidney disease is about 22% among the undiagnosed hypertensive patients and 17% of pre hypertensive patients in the USA (Alam et al., 2014). The exponential increase in the patients with hypertension puts an enormous burden on both the healthcare authorities an healthcare providers.

Eighty percent of this burden occurred in low socio economic and middle-income countries. Prompt and proper management of hypertension can significantly minimize the risk of stroke by 30-41% and of coronary heart diseases by 22%. Despite the availability of effective treatments, studies have shown that in many countries, less than 25% of patients treated for hypertension achieved optimum blood pressure. It is found that early detection, treatment, and control of hypertension are inadequate in low-income countries and awareness about hypertension is also low. Sometimes the situation is even worse (Khanam et al., 2014).

Bangladesh is passing through a phase of epidemiological transition from communicable diseases to non-communicable disease and currently has a double burden of disease (Moniruzzamani et al., 2013). This indicates that the prevalence of hypertension is modest now but will show a rising trend. But only a few studies were done to find out the actual prevalence of essential Hypertension in Bangladeshi people. According to a meta-analysis covering studies up to 1994 reported a prevalence of hypertension among the adult population of Bangladesh is 11.3% (Zaman et al., 2011). Though globally cardiologists play the major role for treating hypertension even at initial stage (Majumder, 2012) but the scenario of Bangladesh is slightly different in this aspect. The primary goal of the management of hypertension is to achieve the maximum reduction in the long-term total risk of cardiovascular morbidity and mortality (Mancia et al., 2007). But owing to unfavourable socio-economic condition most of the people in Bangladesh especially the poor or marginalized people do not consult cardiologist for the initial treatment of hypertension or uncomplicated hypertension. Rather they consult it with village doctors, drug seller and registered physician. Moreover, they are using public health facilities like outdoor services of different tertiary care hospitals. But it is essential to get the proper management of hypertension in due time as this phenomenon usually comes with co-morbid diseases like diabetes mellitus, heart disease, renal disease and other vascular, endocrine and metabolic disorders. Understanding the recent trends of the prescription pattern can be used by Government to ensure supply of appropriate drugs and also helps proper management of subsidies. Therefore, the current study was carried out with an objective to evaluate the Pattern of Drugs prescribed for treatment of hypertensive patients.

Ethical consideration

The researcher was duly concerned about the ethical issues related to the study. Formal ethical clearance was taken from the ethical review committee of the ASA University Bangladesh for conducting the study as well as formal permission was taken from the responders. Confidentiality was maintained properly. Informed written consent was taken from the subject informing the nature and purpose of the study, procedure of the study, the right to refuse, accept and withdraw to participate in the study as well as the participants did not gain financial benefit from this study. The present study posed a very low risk to the participants, as procedures such as medical treatments, invasive diagnostics or procedures causing psychological, spiritual or social harm were not included.

Design and subjects

The current study was part of the Master of Public Health (MPH) thesis under the department of Public Health, ASA University Bangladesh. The descriptive, cross sectional study was conducted at Medicine Outpatient Department (OPD) of Dhaka Medical College Hospital (DMCH); which is a place where initial treatment is provided in hypertensive patients. Data were collected during the period of May 2015 to July 2015 from 100 patients by interviewing with a Bangla semi-structured questionnaire with non-probability purposive sampling. Patients suffering from hypertension above 20 years of age were included in the study. Participants, not willing to participate in the study and visited for the first time to the respective physician were excluded from the sample. After managing data properly it was analyzed in SPSS 16 version and Microsoft Excel Software 2007 version.

Hypertension has become a major health concern in low income countries. This study is one of the few studies that address the prescribing pattern of antihypertensive medications for the patients attending in outpatient department of Dhaka Medical College Hospital. We found an overall high prevalence of hypertension and low prevalence of awareness, treatment and control of the disease. The study highlighted mostly the hypertensive patients though different co morbid diseases like diabetes mellitus, angina, TIA/stroke, renal disease and others were also considered as associated conditions. This survey was conducted in a short period of three months and it is possible that since that time the prescribing pattern might have been changed. Among different classes of drugs most commonly used, drugs among single therapy were angiotensin receptor antagonist (37.3%), Calcium channel blocker (32.8%) and ACE inhibitor (17.9%) subsequently. Noticeably use of Beta blocker was very low (6%). Use of combination therapy for the management of hypertension was significantly high (38.4%) and most favorable combination chosen by the physicians were calcium channel blocker with beta blocker and angiotensin receptor blocker with calcium channel antagonist and both patterns were prescribed at almost equal rate (28.1%) among Bangladeshi people. 25% patients were prescribed angiotensin receptor blocker along with diuretics combination rather than isolated use of diuretics and centrally acting drug like methyldopa and alpha blocker.

Our finding is slightly different from the observation of drug prescribed for hypertension at primary health care facilities in Trinidad in respect of using ACE inhibitor (67.1%), Beta blocker (26.6%) and calcium channel blocker (14.3%) (Clement et al., 2012). Another finding was observed in the department of veterans affairs, United States of America (USA) where there was increased use of ACE inhibitor (range 28.95 to 38.3%), Beta blocker (range 19.9 to 28.6%), thiazide diuretics (range 11.2 to 16.5%), calcium channel blockers (range 20.1 to 28.1%) and angiotensin receptor blockers (range 1.5 to 5.5%)(Lopez et al., 2000). As the national hypertension management guidelines was not available so different experience physicians can also impact the choose of drug during prescription which may influence the prescription  pattern and may linked to the slight difference of pattern from other studies.

In this study, 61.6% patients were prescribed single drug and 38.4% patients were prescribed combined therapy. Whereas, the combination therapy is the most prescribed pattern than mono therapy in Nigeria but male patients were more than female patients which is similar to other studies (Etuk et al., 2008). In this study, combination therapy were prescribed by the physicians about 39% and among them calcium channel antagonist along with beta blocker combination and angiotensin receptor blocker with calcium antagonist were equally chosen by physician and it is 28.1% whereas angiotensin receptor blocker and diuretics combination were preferred 25%. Isolated use of diuretics in combination therapy is significantly low about 3%. Use of monotherapy was more in the study as probably because of improper use of referral system of this country. Most of the people use the tertiary care hospital as a primary treatment centre and single drug therapy was prescribed to manage initial hypertension usually. It was interesting to note that less frequent use of thiazide diuretics in this study which is similar to other study particularly in uncomplicated hypertension though different guidelines suggest the use of thiazide diuretics (Petitti et al., 2006).

The present study represents the prescription pattern of the antihypertensive drugs used in hypertensive patients with associated diabetes mellitus, angina and stroke or TIA which is similar to different studies.