Potential Drug-drug Interactions in Outpatients with Hypertensive Heard Disease
Abstract
Hypertension or high blood pressure have contributed to the occurrence of cardiovascular disease. One of its complication is the development of Hypertensive Heart Disease (HHD). HHD pharmacological treatments usually combine antihypertensive and other agents that lead to polypharmacy. The use of multiple medications or polypharmacy will increase the potential of drug-drug interactions (PDDIs) that affect the therapeutic effect and increase adverse events. This study was aimed to analyze the prevalence and predictor of the PDDIs among HHD patients prescriptions in order to prevent the adverse effects and optimalize the therapy management.
A retrospective observational study was conducted on HHD outpatients prescriptions. Medscape Drug Interaction Checker application was used to identify PDDIs. The mechanism, severity, number of interaction per prescription and most common interaction pairs of PDDIs were documented. In addition, age, gender, and the number of drug prescribed were analyzed as predictors of PDDIs using logistic regression binomial test.
A total of 100 HHD outpatients prescriptions was analyzed and 94 of them had PDDIs. Majority of prescriptions had 3-4 and >4 PDDIs (33.00% each). Total of PDDIs observed were 397 cases. Most of PDDIs happened in the pharmacodynamic phase (86.40%) and need to monitored closely (93.20%). The concomitant use of Candesartan and Bisoprolol was found to be the most commpon interaction pair (11,08%) that can lead to the raise of potassium serum levels. The result of predictors analysis showed that the higher number of drug prescribed the higher the risk of the occurrence of PDDIs respectively (p-value 0,005) which addition 1 drug item will increase the PDDIs 7,232 time higher. In conclusion, the higher number of drug prescribed the closer monitoring need for PDDIs. In addition, closely monitoring in the elevating of potassium serum levels and the symptoms of hyperkalemia are needed in the treatment of HHD outpatients
Keywords:
potential drug interactions, hypertensive heart disease, HHD, hypertension, outpatients
References
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2. WHO. Hypertension Fact Sheets [Internet]. World Health Organization (WHO); 2019 [cited 2021 Mar 31]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
3. Kementerian Kesehatan RI. Laporan Nasional Riskesdas 2018. Jakarta: Sekretariat Badan Litbang Kesehatan; 2018.
4. Tackling G, Borhade MB. Hypertensive Heart Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Mar 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539800/
5. Ningrum AF. Penatalaksanaan Holistik Pada Pasien Hypertensive Heart Disease. 2020;8(1):104–15.
6. Khandeparkar A, Rataboli P. A study of harmful drug–drug interactions due to polypharmacy in hospitalized patients in Goa Medical College. Perspect Clin Res. 2017;8(4):180.
7. Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug–drug interactions. Expert Opin Drug Saf. 2012 Jan;11(1):83–94.
8. Song Y-K, Oh JM. Nationwide prevalence of potential drug-drug interactions associated with non-anticancer agents in patients on oral anticancer agents in South Korea. Support Care Cancer. 2020 Aug;28(8):3711–20.
9. Subramanian A, Adhimoolam M, Kannan S. Study of drug–Drug interactions among the hypertensive patients in a tertiary care teaching hospital. Perspect Clin Res. 2018;9(1):9.
10. Diksis N, Melaku T, Assefa D, Tesfaye A. Potential drug–drug interactions and associated factors among hospitalized cardiac patients at Jimma University Medical Center, Southwest Ethiopia. SAGE Open Med. 2019 Jan;7:205031211985735.
11. Ren W, Liu Y, Zhang J, Fang Z, Fang H, Gong Y, et al. Prevalence of potential drug–drug interactions in outpatients of a general hospital in China: a retrospective investigation. Int J Clin Pharm. 2020 Aug;42(4):1190–6.
12. Georgiopoulou VV, Kalogeropoulos AP, Raggi P, Butler J. Prevention, Diagnosis, and Treatment of Hypertensive Heart Disease. Cardiol Clin. 2010 Nov;28(4):675–91.
13. Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Apr 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470284/
14. Lakkis JI, Weir MR. Hyperkalemia in the Hypertensive Patient. Curr Cardiol Rep. 2018 Feb;20(2):12.
15. Schnaubelt S, Niederdoeckl J, Schoergenhofer C, Cacioppo F, Schuetz N, Spiel AO, et al. Hyperkalemia: A persisting risk. A case report and update on current management. Clin Case Rep. 2020 Sep;8(9):1748–53.
16. Mateti UV, Rajakannan T, Nekkanti H, Rajesh V, Mallaysamy SR, Ramachandran P. Drug-drug Interactions in Hospitalized Cardiac Patients. J Young Pharm. 2011 Oct;3(4):329–33.
17. Murtaza G, Khan MYG, Azhar S, Khan SA, Khan TM. Assessment of potential drug–drug interactions and its associated factors in the hospitalized cardiac patients. Saudi Pharm J. 2016 Mar;24(2):220–5.
18. Shanbhag A, G. H, Sadananda K. Potential drug-drug interactions among hospitalized cardiac patients. Int J Basic Clin Pharmacol. 2016;2251–6.
19. Wastesson JW, Canudas-Romo V, Lindahl-Jacobsen R, Johnell K. Remaining Life Expectancy With and Without Polypharmacy: A Register-Based Study of Swedes Aged 65 Years and Older. J Am Med Dir Assoc. 2016 Jan;17(1):31–5.
20. Chelkeba L, Alemseged F, Bedada W. Assessment of potential drug-drug interactions among outpatients receiving cardiovascular medications at Jimma University specialized hospital, South West Ethiopia. Int J Basic Clin Pharmacol. 2013;2(2):144.
21. Benoist GE, van Oort IM, Smeenk S, Javad A, Somford DM, Burger DM, et al. Drug-drug interaction potential in men treated with enzalutamide: Mind the gap: Drug-drug interaction potential in men treated with enzalutamide. Br J Clin Pharmacol. 2018 Jan;84(1):122–9.
Published
2022-04-30
Section
Articles
