PRESCRIPTION (P-DRUG)

 

Hypertension Treatment

• Country Differences:

  • In the USA: ACE inhibitors (e.g., Lisinopril) are often the first choice for hypertension due to high prevalence of comorbid conditions like diabetes.
  • In India: Calcium channel blockers (e.g., Amlodipine) are commonly preferred due to cost-effectiveness and better efficacy in salt-sensitive hypertension.

• Doctor Differences:

• A cardiologist may prefer beta-blockers (e.g., Metoprolol) for a patient with coexisting heart disease.
• A general practitioner might choose a diuretic (e.g., Hydrochlorothiazide) due to affordability and simplicity.

In contrast, countries relying on the WHO Model List of Essential Medicines may prefer Hydrochlorothiazide due to its inclusion as a cost-effective option.

Impact of Treatment Guidelines

Treatment guidelines provide evidence-based recommendations that directly influence P-drug selection.

• Example 3: Hypertension

• USA (ACC/AHA Guidelines): Recommends ACE inhibitors (Lisinopril) or ARBs (Losartan) as first-line P-drugs for hypertension, especially in patients with diabetes or chronic kidney disease.
• UK (NICE Guidelines): Suggests calcium channel blockers (Amlodipine) as the first choice for hypertension in older adults or Black patients.
• India: Diuretics (Hydrochlorothiazide) are often selected due to affordability and inclusion in national guidelines.

Understanding Clinical Guidelines

• Example 1: Hypertension Treatment

• Doctor A: Interprets the American Heart Association (AHA) guidelines and emphasizes ACE inhibitors (Lisinopril) for hypertension in diabetic patients due to their protective renal effects.
• Doctor B: Focuses on the same guidelines but prefers ARBs (Losartan) because they are equally effective and have a lower risk of cough as a side effect.

"All diseases need not to be treated with a drug."

• Example 1: Hypertension

  • Non-drug approach: Lifestyle modifications such as regular exercise, low-sodium diet, weight loss, and stress reduction can be effective in controlling mild hypertension.
  • Rationale: Drugs may not be immediately necessary, especially in borderline cases.