Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 19483

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 775 - 779

Compliance and Adverse drug Effects of Antihypertensives in Rural India

sunil kale, ameeta patil, r.h. mandlecha

Corresponding Author. Assistant Professor, Department of Pharmacology, Padmashri Dr. Vithalrao Vikhe Patil Foundation Medical College Ahmednagar (MS), India. Professor, Department of Pharmacology, Jawahar Medical Foundation Annasaheb Chudaman Patil Medical College, Dhule (MS), India.

Correspondence Address :
Dr Sunil Kale, Assistant Professor,
Department of Pharmacology,
Padmashri Dr. Vithalrao Vikhe Patil Foundation Medical College
Ahmednagar (MS), India.

Abstract

Background: Hypertension is the most prevalent health problem among adult primary care patients, but its recognition and treatment are suboptimal. Adherence and persistence have been studied in patients of hypertension in this study.

Material and Methods: 491 patients suffering from hypertension and coming to the OPD of a rural medical hospital in Loni were examined in a prospective study over a year after giving the prescribed antihypertensive medication from Oct 2004 to May 2006.

Results: A decrease in blood pressure was observed in patients treated with one pill per day as compared to patients being treated with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. Cost is an important determinant in deciding compliance.

Conclusion: Low dose combination therapy is more effective and is well tolerated than high dose monotherapy. Moreover, the incidence of ADR was observed to be significantly lower with low dose combination therapy in addition to better compliance.

Keywords

Compliance, Antihypertensives, Rural

How to cite this article :

sunil kale, ameeta patil, r.h. mandlecha. COMPLIANCE AND ADVERSE DRUG EFFECTS OF ANTIHYPERTENSIVES IN RURAL INDIA. Journal of Clinical and Diagnostic Research [serial online] 2011 August [cited: 2019 Aug 23 ]; 5:775-779. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=August&volume=5&issue=4&page=775-779&id=1460

Hypertension is a common cardiovascular disorder, which is an important risk factor for coronary artery disease. Though many drugs are available for the treatment, it still remains poorly controlled in both industrialized and even more prevalent in developing countries (1), (2). Poor compliance to the prescribed drugs poses a major problem among patients with hypertension, heart disease, depression and others. A special case of non compliance is the primary non compliance, patients not redeeming their prescriptions (3). It is a well known fact that frequency of doses play an important part, single dose has been found to improve compliance but 24 hour antihypertensive activity should be provided by the drug (4)(5) (6).

Patient’s non compliance with the therapeutic regimen has long been a challenge for practitioners, hence this study has been undertaken to investigate the adherence and persistence of antihypertensive drugs in Indian rural population as well as monitoring adverse drug reactions and its relation to compliance.

Material and Methods

The study model included 491 patients visiting the OPD of rural medical hospital in Loni who were diagnosed with stage I and II hypertension from Ist Oct 2004 to Ist may 2006 (Table/Fig 1). Ambulatory patients aged 30 to 60 years with newly diagnosed stage (SBP 140-159 and DBP 100-109 mmhg) and stage II (SBP 160-179, DBP 100-109 mmhg) hypertension, as defined by the sixth report of the joint committee on prevention, detection, evaluation and treatment of high blood pressure were included. However, patients with stage III or secondary hypertension or a history of myocardial infarction, cardiac intervention or stroke, pregnant or breast-feeding women and patients with cardiac, hepatic, renal neurological, metabolic or any other systemic disorder were excluded from the study. Also patients with raised transaminases,serum creatinine and patients hemoglobin of less than 10 gm/dl were also excluded from the study.

Patients fulfilling the inclusion and exclusion criteria were enrolled and treated for hypertension in a follow up of one year, with evaluation of their demographic profile and medical history by self prepared questionnaires, and assessment of vital signs at each visit every month, while laboratory tests were conducted at the beginning and end of study. Treatment was initiated with one or a low dose combination of atenolol, enalpril, losartan, amlodipine or hydrochlorothiazide and patients were monitored for adverse drug events. During follow up patient’s BP was measured as an average with readings taken at 10 minutes interval with a standard mercury sphygmomanometer. Patients were made to complete a medication compliance card and were assessed according to a pro-forma.

The level of compliance was determined by the medical compliance card at the end of study and a patient was considered compliant with the study medication if at least 86 percent of the study medications had been applied/consumed according to prescribed regimen. The compliance was considered satisfactory when the mean compliance was more than or equal to 86 percent, which corresponded to taking medication for six or seven days per week on an average (7). Adverse reactions were divided into mild, moderate, or severe and assessed for date of onset, duration and action taken regarding study drug. Statistical evaluations were made using t-test and Z test to obtain relevant p values.

Results

The study cohort included 293 men (mean age, + SD 45.6 + 9.8 years), and 198 women (47.6 + 8 years) [Table/Fig-1]. Of the 208 participants taking one pill everyday, 76 were regular attendees while 132 were irregular attendees to the follow up visits and were associated with a mean satisfactory compliance of 58 percent and 6.2 percent respectively. The mean satisfactory compliance was 39 percent and 4.9 percent in 23 and 52 participants who took two pills a day, respectively. The study group taking three pills aday were associated with a mean satisfactory compliance of 28.3 percent and 3.7 percent in 12 regular and 25 irregular patients, respectively (Table/Fig 2), (Table/Fig 3), (Table/Fig 4).

The mean blood pressure in the initial 491 patiens was 159 + 14/100 + 09 mmHg. The fall in blood pressure was insignificant for patients who dropped out of treatment (p>0.005).

Mean blood pressure at the end of treatment at one year was 149 +11/96 + 8 mmHg for the continuing patients, whereas the mean difference in blood pressure before treatment and at 12 months of treatment was 17 + 11/11+ 6 mmHg for participants taking medication 6-7 days per week, 11 + 6/8 + 7 for those taking medication 4 to 5 days a week and 5 + 8/5 + 4 for those takingmedication for zero to three days a week. Differences between highest and lowest compliance categories were significant both for systolic and diastolic blood pressure measurements (p< 0.005).

Optimal blood pressure control was only achieved in 8.6 percent participants which is consistent with many Indian studies (8)(9) (10).

Cost of therapy adversely and inversely affected the compliance to treatment (Table/Fig 5). Many adverse drug reactions were observed which included dry cough (n=10), which subsided in all patients except two who had to be shifted to losartan therapy, weakness (n=13), headache (n=4), mild dizziness (n=11), dryness of mouth (n=12) and one patient with ankle swelling (Table/Fig 6). Low incidence of adverse drug reactions could be attributed to the use of low dose combinations instead of high dose monotherapy.

Discussion

The results of this study showed that only 58 percent of the participants taking one pill a day and visiting regularly maintained satisfactory compliance to medication over a period of 12 months. The lowest level of compliance was associated with patients taking three pills a day with 28.3 percent in patients visiting regularly and 3.7 percent in those visiting irregularly which suggested that number of pills is directly proportional to compliance level. Percentage of drop outs from the therapy also increased with the increase in thenumber of pills per day, with 32 percent for patients taking one pill per day to 45.6 percent for patients taking three pills per day. A total of 171 patients dropped out during the therapy.

A decrease in compliance was seen over time, particularly in the first three months which could be attributed to decrease in motivation since it’s a silence or its association with real or imaginary discomfort.

Combination therapy is advantageous as compared to monotherapy, which is shown in the higher response ratio for the former (11) (12). Review of literature emphasis on the fact that compliance is better in patients taking simpler form of medication regimes than the complicated ones (13)(14)(15)(16)(17).

Blood pressure was found optimally reduced in 8.6 percent in the study, while the NHANES III survey found that optimal blood pressure control was only 23 percent in the American population (10). Satisfactory results for compliance were associated with a greater decrease in blood pressure as compared to poor compliance (18) (19).

Many factors were found associated with low compliance which included male gender, young age, initial drug choice, education level, living alone, unemployment including others (20)(21)(22). Education was tied to better compliance since they have a better understanding of the long term consequences (23) (24). Cost of the antihypertensive drug therapy was found to be inversely proportional to compliance (25) (26). Patients on multiple therapy were more likely to develop adverse drug reaction as compared to patients on monotherapy (27) (28).

Dry cough was associated with enalpril and losartan while amlodipine and thiazide was associated with mild headache. Thiazide was also found associated with increased frequency of micturition in the patients. One patient on amlodipine therapy reported of ankle swelling. Mild severity of side effects could be attributed to low doses used in combination therapy.

Conclusion

Low dose combination therapy is more effective and is well tolerated than high dose monotherapy. Moreover, the incidence of ADR was observed to be significantly lower with low dose combination therapy in addition to better compliance. The low level of compliance to antihypertensive medication found in this study, is consistent with findings in other countries and studies inIndia, emphasizing the need of population wide primary prevention of elevated blood pressure and cardiovascular disease. Such measures include educational, legislative, and fiscal actions to encourage the adaptation of a healthy diet and to increase the facilities and opportunities for physical activity at leisure.

Acknowledgement

JCDR services (Dr. Shivangi sharma) were used for the final drafting of the article.

References

1.
Pardeshi milind et al, Comparison of efficacy and safety of amlodipine and felodipine-ER in patients of essential hypertension.
2.
Nissinen A et al, Hypertension in developing countries, World Health statistics quarterly, 1998;41:141-154.
3.
Kumar Praveen et al, Cardiovascular disease, Kumar and clarke’s clinical medicine, 2002, 5th edition, 818.
4.
Boon N A et al, Cardiovascular disease. Davidson’s principals and practice of medicine 2002, 19th edition, 392.
5.
Hamilton R A, Bricelaand L L, use of prescription refill lrecords to assess patient compliance, 2009;49:1691-1696.
6.
Cockburn J, Gibbered R W, Reid A L, Sanson Fisher R W, determinants of non-compliance with short term antibiotic regimen, BR medical Journal, 1987; 295: 814-818.
7.
Pascal Bovet et al, Electronic compliance monitoring in resistant hypertension: basis of rational therapeutic decisions, Journal of Hypertension 2001; 19: 335-341.
8.
Hypertension study group: Prevelance, awareness, treatment, and control of hypertension among elderly in Bangladesh and India: a multicentre study. Bull World Health Organ 2001, 79 (6) :490-500.
9.
Deedwania P, Gupta R. Hypertension in South Asians. In: Izzo & Black. Editors. Primer on Hypertension. American Heart Association 2002; 890-997.
10.
Gupta R, Gupta VP, Sarna M, Bhatnagar S, Thanvi J, Sharma V, et al. Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J. 2002: 54:59-66
11.
Dolan E, Stanton AV, Thom S, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients – an Anglo-Scandinavian Cardiac Outcomes Trial substudy. J Hypertens. 2009;27:876-885.
12.
Ram CV. Antihypertensive drugs: an overview. Am J Cardiovasc Drugs. 2002; 2:77-89.
13.
Chihara A, Kaneshiro Y, Sakoda M, et al. Add-on amlodipine improves arterial function and structure in hypertensive patients treated with an angiotensin receptor blocker. J Cardiovasc Pharmacol. 2007;49: 161-166
14.
Bangalore S, Kamalakkannan G, Parkar S, et al. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007;120:713-719.
15.
Mallion JM, Chamontin B, Asmar R, et al. Twenty-four-hour ambulatory blood pressure monitoring efficacy of perindopril/indapamide firstline combination in hypertensive patients: the REASON study. Am J Hypertens. 2004;17:245-2.
16.
Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913.
17.
Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-2572.
18.
Miura K, Daviglus ML, Dyer AR, Liu K, Garside DB, Stamler J, et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Archives of Internal Medicine 2001;161:1501-8.
19.
Cooper RS, Rotimi CN, Kaufman JS, Muna WF, Mensah GA. Hypertension treatment and control in sub-Saharan Africa: the epidemiological basis for policy. BMJ 1998 ;316:614-7.
20.
PREMIER Collaborative Research Group, Effects of Comprehensive Lifestyle Modification on Blood Pressure Control: Main Results of the PREMIER Clinical Trial. Journal of the American Medical Association, 2003; 289, 2083-2093.
21.
Gilchrist L.D., Schinke S.P. Coping With Contraception: Cognitive and Behavioral Methods with Adolescents, Cognitive Therapy Research, 1983;7,379-380.
22.
Bandura A. Analysis of Self-Efficacy Theory of Behavioral Change, Cognitive Therapy and Research, 1977;1,287-310.
23.
Colombo Plan for Co-operative and Economic Development in South- East Asia, 22nd Consultative Committee. Sri Lanka, Colombo Plan Bureau, 1972; 990-998.
24.
Dr Ramachandram P., New insights in treatment of hypertension; The association of physicians, India,: Medicine update 2002;556.
25.
Lesaffre E. A retrospective analysis of the effect of noncompliance on time to first major adverse cardiac event in LIPS. Clin Ther. 2003;25:2431-47.
26.
Halpern MT, et al. Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension. 2006;47:1039-48.
27.
Guidelines Committee. 2003 European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011-1053.
28.
Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004;22:11-19.

DOI and Others

JCDR/2011/1460

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com