الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypertension is considered an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular, cerebrovascular and kidney diseases. However, the pharmacologic treatment is one of the most important tools in management of hypertension but a serious problem in the management of hypertension which is the phenomenon of non-compliance with antihypertension medications. The importance of drug utilization studies has been increasing due to their close association to other areas like- public health, pharmacovigilance, pharmaco-economics and pharmacogenetics. The study was conducted to evaluate patients’ compliance accompanied with the pattern of use of the needed and preferred antihypertensive drugs in the Egyptian market by patients or doctors in order to determine the extent of use of different antihypertensive drugs in Alexandria to ensure that more than one drug is available at lower cost to the patient. Moreover, assessment of the degree of patient compliance and the most probable causes of patients’ noncompliance to the antihypertensive drugs were investigated.
This study was conducted in two phases where the lists of medicines registered with the Egyptian Ministry of Health were prepared during the years 2006 to 2015 and classified according to pharmacological classes and active constituents. The results of sales of these drugs were then extracted from the sales records of drug distribution company Alexandria for the period from 2006 to 2015. The second phase was a cross sectional study on a number of 600 hypertensive patients who visited different community pharmacies in Alexandria and determine the types of treatments they have received and their assessment of the cost of treatment and their compliance to treatment and the potential reasons for noncompliance if there.
The data was analyzed after testing its normality and the appropriate statistical technique was adopted.
The study revealed the existence of a large and increasing number of antihypertensive drugs that are registered in Egypt annually in most therapeutic groups in general and by recording the number sold units of anti-hypertensive medicines in Alexandria increased five folds from 2006 to 2015.The study showed that although the percentage of the registered generic antihypertensive drugs increased from 65% to about 75% from 2006 to 2015, but the brand drugs are still accounted for 52% of the total sold units of antihypertensive drugs. In addition, the number of sold units in some pharmacological groups is nearly doubled as in Alpha receptor blockers, angiotensin enzyme inhibitors, beta receptor blockers and (angiotensin receptor blockers plus diuretics).This study showed that 75% of patients were treated by drugs containing one active ingredient (monotherapy), among these drugs, the most common prescribed and sold pharmacological groups were beta blockers (32.6%) and angiotensin enzyme inhibitors (22.6%).Diuretics were extensively sold but it is not used widely as a single hypertension treatment among the suited sample of hypertensive patients, the high sales of diuretics may be for another clinical uses other than treatment hypertension, but at the same time diuretics were used to treat hypertension with other antihypertensive drugs in 75% of the used combination therapy, especially angiotensin inhibitors (32.6%) and beta blockers in (30.2%) and Angiotensin receptor blockers.
The most commonly prescribed antihypertensive drugs were Bisoprolol, Atenolol, Amlodipine, Captopril, Candesartan, Indapamide, Lisinopril, Spiranolactone, Furosemide, methyl dopa and combination drugs (Enalabril + Hydrochlorothiazide), (Bisoprolol + hydrochlorothiazide), (Valsartane + Hydrochlorothiazide), (Valsartane + Amlodipine), (Captopril + Hydrochlorothiazide).
An average cost reduction of 50.2% ± 15.7% can be obtained by replacing the high frequent prescribed with the equivalent lowest-priced generic drugs.
Only 22.8% of patients had blood pressure within the required control range and more than 63.0% of patients had hypertension comorbidities, especially cardiovascular disease, which accounted for 28% of patients and kidney disease, which was determined in 14.7% of patients.
Concerning the patient compliance to treatment, the study revealed that although more than 92% of patients take treatment according to medical prescription and more than 83% of patients considered adherence to treatment high important issue, but only 30.5% of patients have high compliance to their antihypertensive treatment. And There was a significant association between the level of compliance to treatment and the emergence of complications x2 = 35, p = 0.000, and with ability to get acceptable blood pressure control limit x2 = 267, p = 0.000.
About 48.8% of patients considered their treatment were highly cost and regarding the reasons of non-compliance, forgetting to take the drug dose was reported by 45.3% of noncompliant cases while high cost of treatment was reported by 40.5% of noncompliant cases and boredom, feeling well were reported by 23.7% and 23.5% of noncompliant cases respectively.
The study did not find any significant relationship between age, patients’ marital or educational level or occupational status with the level of treatment compliance.
On the other hand, there was a significant correlation between the sex, number of drugs used for treatment, the duration of hypertension and the level of treatment compliance, binary logistic regression was adopted to find the significant predictors of compliance to hypertension treatment, Three variables were the significant predictors: sex as the likelihood of noncompliance among males is 1.6 times relative to females, prolonged duration of the disease as well as number of drugs used in the treatment are significant predictors of non-compliance (OR = 1.04, 1.65 respectively).from the above results, the following recommendations can be obtained:
It is recommended that the Egyptian guidelines for the treatment of high blood pressure and consider the dimensions of the problem of the patient’s compliance to treatment, whether due to the cost of treatment or other causes of non-compliance. It is also recommended to create comprehensive educational programs for all members of the medical team to explain how to increase the patients’ compliance to medicines To encourage the use and prescription of generic medicines among doctors and provide an updated evidence based scientific references which enact the bio-equivalency of these drugs to ease the choice between generic alternatives according to patients’ status.The Ministry of Health should encourage the process of registration and licensing and production of generic medicines, but giving priority to therapeutic groups and the most effective active substances for needed by patients.To emphasize the role of the physician, pharmacist and family in continuous communication and encourage and motivate the patient for more compliance.To encourage researches to develop new methods which help patient reminding treatment dose regimen to guarantee more commitment to treatment.