KATHMANDU UNIVERSITY JOURNAL OF SCIENCE, ENGINEERING AND TECHNOLOGY

[Link], No.1, FEBRUARY, 2006.

STUDY OF DRUG USE IN ESSENTIAL HYPERTENSION

AND THEIR COMPLIANCE
Mili Joshi, Rao B.S., Khan G.M.
Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre,
P.O. Box: 6250, Kathmandu, Nepal.
Corresponding author E-Mail: profsrao@[Link], pharmacy@[Link]
ABSTRACT
Hypertension (HTN) affects approximately 1 billion people worldwide. The prevalence of
HTN increase with age and even further unless broad and effective preventive measures are
implemented. Significant age, obesity, lifestyle, smoking and alcohol use related factors in
prevalence of essential HTN were seen. The use of drugs was observed related to different
factors. Out of total 156 patients, the distribution of Antihypertensive Agents (AHA) used
were Calcium Channel Blockers (65%), Beta Blockers (52%), Angiotensin convertin enzyme
inhibitors (19%), Diuretics (28%) and Angiotensin Receptor Blockers (9%). Among
individual drugs, 102 patients were on Amlodepine, 39 on Hydrochlorthiazide, 82 on
Atenolol, 14 on Losartan, and 30 subjects were on Enalapril. With respect to overall
utilization, Calcium Channel Blockers (Amlodepine) were observed to be the most frequently
prescribed AHAs, Beta Blockers (Atenolol) ranked second followed by Angiotensin convertin
enzyme inhibitors (Enalapril), Angiotensin Receptor Blockers (Losartan) and Diuretics
(Hydrochlorothiazide). Within each class of AHA used the most frequently used were
Calcium Channel Blockers, (Amlodepine- 97.14% and Nefidipine- 2.86%) followed by Beta
Blockers (Atenolol 97.6% and Metoprolol 2.4%, Angiotensin convertin enzyme inhibitors
(Enalapril 96.77% and Lisinopril 3.23%), Diuretics (Hydrochlorthiazide 88.63 %and Loop
Diuretics 11.35%), Angiotensin Receptor Blockers (Losartan). Both in monotherapy and
combination therapy, the most preferred AHA remains Amlodepine. In combination therapy,
the most extensively used combination was Amlodepine with Atenolol. Calcium Channel
Blockers were appropriately prescribed in significant number of patients above 50 years.
Angiotensin Receptor Blockers account for a very small proportion of drug use profile, which
may be due to the high cost and lower availability of these drugs. The general pattern of
antihypertensive agent utilizations appears to be within the recommendation of British HTN
Society Guidelines.
Key words:
agent-AHA

Hypertension-HTN, Essential hypertension, Compliance, Antihypertensive

INTRODUCTION
Blood pressure is the pressure exerted on the lateral wall of the blood vessel by the flowing
blood. It depends on blood flow (how much blood is pumped by your heart) and the
resistance of blood vessels to blood flows. If the pressure is high, the heart must work much
harder to maintain adequate blood flow to the body.
Hypertension (HTN) is the term used to denote elevated blood pressure. It is defined as the
condition in which the blood pressure remains consistent to Systolic Blood Pressure (SBP) >
140mm Hg and Diastolic Blood Pressure (DBP) > 90mm Hg.1 HTN can lead to heart disease,
kidney disease, ocular disease or blindness and stroke. HTN is one of the major public health

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problems in Nepal. Here it is an iceberg condition and the prevalence of HTN has been
considered as an increasing silent killer problem along with rapid urbanization.2
High blood pressure is called "the silent killer" because it usually has no symptoms. Some
people may not find out they have it until they have trouble with their heart, brain, or
kidneys2. Arterial HTN, which is one of the main causes of coronary vascular disease, is
responsible for nearly 20% of all deaths worldwide (nearly 10 million). These are the
principal cause of death in all developed countries accounting for 50% of all deaths and are
also emerging as a prominent public health problem in developing countries, ranking third
with nearly 16% of all deaths.3
High blood pressure is a risk factor for death from cardiovascular causes such as heart attacks,
heart failure, and stroke, but also from kidney failure and blood vessel disease.4, 5, 6, 7, and 8 with
proper treatment however, this risk can be reduced. In randomized controlled studies of drug
treatment of HTN, one-third reduced stroke mortality, whereas one-fourth reduced mortality
from coronary artery disease. 9
Arterial HTN (AH) is the most common cardiovascular disease and is a major public health
problem in the world. It produces a marked effect on patients, relatives and society, either
because of HTN per se or through its complications (stroke, heart attack, ischaemic heart
disease, renal dysfunction and heart failure), which can produce premature death or
permanent disability. The risk of developing a cardiovascular complication is higher when the
individual combines HTN with other risk factors such as hypercholesterolemia/dyslipidemia
or smoking.3
It is known that more than 95 % of hypertensive patients in the community are of essential
(idiopathic/unknown) aetiology and only a small percentage has an identifiable cause
(secondary HTN). Epidemiological evidence also shows that there are several factors which
play an important role in the development, evolution and prognosis of arterial HTN, some of
them non-modifiable, such as age, sex, ethnicity and heredity, and others modifiable, such as
body weight, salt intake, alcohol intake, use of hormonal contraceptives and drugs retaining
sodium, sedentary life and psychosocial factors. 3
Researches have shown that it is highly advisable to reduce and maintain the blood pressure
to normal due to the various complications that arise due to high blood pressure. For this
purpose numbers of antihypertensive agents (AHA) are used. Number of guidelines like Joint
National Committee for the prevention Detection evaluation and Treatment of High Blood
pressure (JNC 7th) report, British Hypertension Society Guidelines (BHSG), and 2003
European Society of Hypertension (ESH) European Society of Cardiology guidelines for the
management of arterial HTN suggests various protocols to be followed while using
antihypertensive agents (AHA) for the treatment of different stages of essential HTN.
Besides using drug therapy for controlling HTN, lifestyle modification also termed as nonpharmacological therapy can decrease and help to control BP in many people with HTN.
These changes are useful by themselves or when implemented in conjunction with drug
therapy. They can enhance the efficacy of AHAs and decrease cardiovascular risks and may
even reduce the number of required drugs and their dosage. Major lifestyle modifications
shown to lower BP include weight reduction in those individuals who are overweight or
obese, 10, 11 Adoption of the Dietary Approaches to Stop Hypertension (DASH) 12, 13 eating
plan which is rich in potassium and calcium, dietary sodium reduction, 1214 physical

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activity, 15, 16 and moderation of alcohol consumption.17. For example, a 1,600 mg sodium
DASH eating plan has effects similar to single drug therapy.12 Combinations of two (or more)
lifestyle modifications can achieve even better results.
Apart from all the above factors, patients compliance to the therapy is it pharmacological or
non-pharmacological, is the key factor. Compliance involves not only taking the prescribed
medications but also adherence to follow-up appointments and maintaining the recommended
lifestyle modifications. Furthermore, the patient should be an active participant in the plan of
care. Patients' knowledge of HTN and its complications is an important factor in achieving
better compliance, and hence control.18
The objective of this study was to assess drug use pattern and compliance of antihypertensive
agents in essential HTN, to assess the drug use pattern in terms of class and action of
antihypertensive drugs, to evaluate the compliance of the antihypertensive agents used in
terms of reduction in the blood pressure to goal BP and to evaluate the risk factors related to
HTN and their effect on therapy.
MATERIAL AND METHOD
The study included two national level hospitals: Sahid Gangalal National Heart Center
(SGNCH) and Tribhuvan University Teaching Hospital (TUTH). SGNHC is a national level,
specialized hospital for cardiac care and TUTH major referral tertiary care hospital. Both
hospitals are situated inside the Kathmandu valley. Since SGNHC is a specialized hospital the
density of patients with heart related problems was higher than in TUTH.
This is a quantitative, prospective study involving review of available documents and
interviewing the patient during regular physician visits. The patients were followed up for
their blood pressure change after 2 weeks of the interview. The patients with controlled blood
pressure during the interview were not followed up.
Size of sample: The total of 156 patients who met the inclusion criteria were collected form
SGNHC and TUTH .104 patients from SGNHC and 52 from TUTH (n=156). This difference
in the no of patients is because of higher density of hypertensive patients at SGNHC than at
TUTH. The patients were selected randomly during the regular physician visits in out patient
departments (OPD) of SGNHC and TUTH.
Inclusion Criteria: Age years; Patient with Stage1and Stage2 HTN; Currently or had
previously been treated with at least one antihypertensive medication; with no surgical history
Exclusion Criteria: Patients detected with target organ damage like Left Ventricular
Hypertrophy Microalbuminurea, Radiological or extensive ultrasound evidence of
atherosclerotic plaque, Generalized or focal narrowing of the retinal arteries; With other
cardiovascular risk factors like Ischemic stroke, Cerebral hemorrhage, Transient ischemic
attack Myocardial infarction, Angina, Coronary revascularization, Congestive heart failure;
Patients with prehypertension which do not require drug therapy.
Tool of data collection and technique: Data collection was done by developing a structured
questionnaire for interview with the out patients and from the patient history records available
at the hospital. Preliminary questionnaire was prepared and field-tested for 7 days. Pre-testing
for the data collection tool was done 15 patients. And possible modifications were done to
make the subjects easily understandable and convenient. The total no of the physicians in both

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the hospitals who were involved in prescribing was 18. The technique used for sampling was
non-probability sampling.
Study Variables: age, sex, occupation, smoking/alcohol use status, hereditary links, Blood
pressure status, Total No. Of drug prescribed, No of classes of drugs prescribed, Compliance
to the drugs used.
Data analysis: The collected data were coded as per variables and entered in SPSS data sheet
and analyzed using the SPSS-PC statistical software (SPSS for Windows, version 10.0).
Pearsons chi- square tests were used to determine the relationship between the use drugs and
patient demographics. Chi square analysis was also performed to evaluate the association
between the variables. Ninety-five percent (95%) confidence interval (CI) was also reported
when appropriate. P<0.05 was considered statistically significant.
Using Microsoft Excel 2000, generated graphs.
RESULTS AND DISCUSSION
A total of 156 patients were included from SGNHC and TUTH from Jan 2004 to Mar2004.
Among which 75 female and 81 male aged over 18 years were under medication for the
treatment of essential HTN. The ratio of male to female was 1.32:1
Among the total sample, 40.4 % of 156 patients were diagnosed having stage 1 HTN, 56.4 %
having stage2 HTN and only about 3.2 %having isolated systolic HTN.
More than half of the total subjects included in this study had stage2 HTN. It has been
reported that increase in blood pressure occurs progressively through out the age and that
about two third of the elderly can be defined as hypertensive with stage two HTN. 19 In this
study more than 50% of the subjects fall under the age group >50 years .due to this greater
proportion of above 50s patients the incidence of stage 2 HTN may have become greater. It
was found that about 3% of the patients were of age group in the range of 20-29, 13% were
between 30-39, 31% between 40-49, 29% between 50-59 and 24% of the patients were above
60years of age. The result that the incidence of HTN is greater in patients above 50 years of
age is supported by the longitudinal data collected over a 30-year period has shown that the
prevalence of HTN increases with age. 20
This study also showed that the proportion of stage2 HTN is high in the age group between
40-60 years. Stage 2 HTN is not observed in the age group [Link] prevalence of
isolated systolic HTN is highest in the elderly i.e. age >60. It was observed in a study that the
incidence of HTN increases with age. In that too the incidence of stage2 HTN is particularly
high in above 40s group which supports the findings of European Working Party on High
Blood Pressure In The Elderly Trial (EWPHE) which suggests that the blood pressure
increases progressively with age.19 But this association is not statistically significant at
p=0.057, p>0.05.
The study showed that 52% of the subjects were not engaged in any job whereas 31 % have
jobs of sedentary nature and only 17 % have jobs, which include physical activity. This
results shows that the incidence of HTN is less common in patients who have jobs that
involve physical activity that those that led sedentary lifestyle. The highest percentage of the
patients was without jobs. They were either housewives or retired and stay home. This could
be because international guidelines suggest that regular physical activity is also one of the

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factors responsible for BP lowering in hypertensive patients so the result meets the hypothesis
that HTN is related to the life style relating to occupation.12, 21.22
Weight, height and blood pressure were recorded during the visit. Body mass index (BMI)
was calculated as weight in kilograms divided by the square of height in meters. A BMI of
27.8 kg/m2 for men and 27.3 kg/m2 for women was considered high.
Body mass index category
Category
BMI*
Underweight
<18.5
Normal
18.5-24.9
Overweight
25-29.9
Obese
>30
*BMI calculator; National Heart Lung and Blood institute
It was observed that out of 156 subjects included in the study, 54% were overweight, and 8 %
were obese.37% forms the group with normal BMI and a very small % of 1% were under
weight. The highest percentage of the hypertensive group falls under the category of
overweight. BMI greater than 24.9-kg/sq m is a contributing factor the essential HTN and
obese/overweight people are more prone to have elevated blood pressure.10 The result
confirms to the previous findings that HTN is associated with BMI or weight.
As for the use of alcohol, 5.1 % are using alcohol although they are aware that they have
HTN, 59.6 % have not used alcohol ever, 5% of the subjects used to take alcohol but have left
now, and 10.3% used to take alcohol but have reduced their amount and frequency after the
diagnosis. Xin X, He J, Frontini MG, et al has suggested that alcohol use reduction is on of
the major life style modification which have positive affect on blood pressure reduction.17 The
results also suggests that a significant no of people are following the advice of reducing their
alcohol intake. Though more than 50% are non-alcohol users, the category of alcohol users,
who have left alcohol after diagnosis, ranks second in the percentage, which is an
encouraging sign to the health care professionals.
Though smoking is one of the risk factors for HTN, 98 patients have never taken up smoking
ever. This group mostly consists of housewives. About 29% use to smoke but have left after
the diagnosis.4.5% have not quit smoking though they know they have HTN whereas 3.2 %
have reduced their no of sticks per day. The percentage of the smokers who have left forms
29%. Smoking contributes to elevated blood pressure due to higher level of thromboxane
which is a vasoconstrictor though no specific data is available about its being the cause of
HTN. Since smoking directly affects the lungs there is maximum chance of it to affect the
circulatory system. International guidelines suggest cessation of smoking as one of the major
step in improving the lifestyle for the reduction of the blood pressure. 23
In overall observation i.e. in both monotherapy and combination therapy the highest use
antihypertensive drug is CCBs 67% followed by beta blockers54%, diuretics 28%, ace
inhibitors 19.8% and ace receptor blockers 9%. (Fig: 1)
British HTN society guideline (BHSG) recommends use of either [ACEI or BB] or [CCB or
Diuretic]. 23 The result obtained indicated the high use of CCBs. This may be because the
subjects were chosen such that they had no complications and CCB is preferred in case of the
5

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treatment of hypertension with no complications. This may also be because of the easy
availability, physicians prescribing trend or may even be affected by heavy promotion of the
drugs by the manufacturer. It was also observed that physicians follow the British guideline
and the pattern meets the guidelines suggested by BHSG.
It was observed that out of 105 subjects, who were on CCBs, 102 were prescribed amlodepine
and only 3 were prescribed Nefedipine. Similarly, out of 41 subjects on diuretics 39 were
prescribed Hydrochlorthiazide and 5 were prescribed Frusemide, out of 84 subjects on beta
blocker 82 were prescribed atenolol and only two were prescribed Metoprolol, out of 14
subjects who were prescribed ARB, all were prescribed losartan, and out of 31 subjects on
ACEI, 30 were prescribed enalapril and only one was prescribed Lisinopril. (Table: 1)
Atenolol, amlodepine and enalapril were found to be the most extensively used AHAs. This
could be due to the easy availability and physician trend in the hospital. Also that most of the
combination regimens include atenolol or amlodepine. This use also meets the
recommendation made by the BHSG .23
In 66 patients receiving monotherapy, the most prescribed AHA is CCBs 45.45%, then 25.8
% were prescribed beta-blockers, and 16.7% were on ace inhibitors. Only 4.5% and 3% were
on ace receptor blockers and diuretics respectively. (Fig: 2)
This indicated the high use of CCBs when monotherapy for essential HTN is concerned,
followed by BB and ACEI. Since a major proportion of the sample comprises of the above 50
years age group, the use of CCB has been extensively done because drug of choice for the
patient above 55 years of age is CCB or Diuretic. Diuretics are not as much used, as it should
be because of the reason including heavy promotion of other medications and the perception
that diuretics produce adverse metabolic effects and do not reduce coronary heart disease
events. 24As far as a specific drug for monotherapy is concerned; recommendations have been
very flexible. Researches have also shown that there is a very minor gain in switching the
drugs between ACEI or BB and CCB or Diuretic. 23
The study showed that out of the total subjects included in the study, 42.3% were on single
drug therapy, 38.5% were on two-drug therapy, 17.9 % were on triple drug therapy and only
1.3 % was on four drugs. The use of single and two-drug therapy is higher in proportion
(80.8%). HTN guidelines suggests the use of single drug initially and to add up according to
the patients response to the drug. The use of triple drug therapy is mainly low in proportion
and is only used in cases when the double drug fails to achieve the goal BP. The use of 4
drugs for the treatment of HTN seems irrelevant and also doesnt meet the recommendations
of the guidelines. But in some cases due to the physiological requirements and in emergency
cases, the physicians add four-drug combination.
Out of 60 subjects, in which two drug combination were used, 50 % f the subjects got the
combination of amlodepine and atenolol followed by amlodepine and diuretic (21.66%) and
amlodepine and enalapril (8.3%) and atenolol and diuretic (8.3%) and the least used were
atenolol and enalapril (5%) and atenolol with losartan (3.3%). (Fig: 3)
Two drugs therapy are used only when single drug combination fails to achieve target BP.23
The choice of drugs in combination therapy was seen to include conventional drugs and there
was little impact of the newer drugs on prescribing. This may mainly be due to the
unavailability of the newer molecules.

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The highest prescribed combination of three drugs is amlodepine atenolol and enalapril
(CCB+BB+ACEI) 50% of all the subjects in which three drug combination were used
followed by the combination of amlodepine+atenololo+losartan (10.7%) Fig: 4.
Use if three drug combinations were initiated in stage 2 hypertension only when the two-drug
combination fails to lower the BP to goal BP. In most of the cases ACEI was added after the
combination of atenolol and amlodepine was insufficient.
Out of 81 male patients, 65 have blood pressure controlled at goal blood pressure of
SBP<140mm Hg and DBP<90 mm Hg and 16 have Bp greater than goal BP. Similarly out of
75 female patients, 60 have their BP controlled to goal BP and 15 have BP greater than goal
BP. There is no association between the controls in BP to goal BP with the sex of the patient
(p=0.561, p>0.05) .The overall compliance of the pts does not appear to be affected by age or
sex. 25
Out of 125 patients who have controlled HTN 74(59.2%) patients were on combination
therapy and 51(40.8%) were on mono therapy whereas out of 31 patients with uncontrolled
HTN 15(48.4%) were on monotherapy and 16(51.6%) were on combination therapy
(Table: 1).
The results showed the higher proportion of the subjects with the controlled blood pressure
were on combination therapy. But this result could be affected by the result obtained
previously that combination therapy is mostly prescribed in stage 2 HTN. The control is
related to the type of HTN of the subjects and the prescribed therapy. The blood pressure was
effectively controlled by combination therapy rather than by monotherapy while keeping the
diagnosis controlled.
The result shows that in the patients with stage 1 HTN, 55.6 % were prescribed monotherapy
and 44.4 % were prescribed combination therapy. Similarly inpatients with stage2
hypertension 67% were treated with combination therapy and 33 % were treated with
monotherapy and in patients with isolated systolic HTN 40% were treated with monotherapy
and 60% were treated with combination therapy. (Table: 3, Fig: 5)
In large proportion of stage 2 HTN (67%), combination therapy is used than in stage one
HTN, which is only 44.4%. BHSG also recommends the use of combination therapy in stage
2 HTN. The use of monotherapy is not adequate for the control of stage 2 HTN. The use of
combination therapy in isolated systolic HTN is relevant because systolic HTN is difficult to
control and combination therapy is appropriate.
The use of combination therapy is initiated in stage 1 HTN only when the monotherapy fails
to control the Bp to goal BP. The over all use of combination and monotherapy in different
stages of HTN meets the recommendation of BHSG 23 There is a significant association
between the type of therapy used and the type of hypertension (p=0.012, p<0.05)
CONCLUSION
The evidences observed in this perspective study, which was done at two national level
hospitals inside the Kathmandu valley, showed that CCBs, BBs and ACEIs were the most
used classes of AHAs in both monotherapy and combination therapy. Among these different
classes also specific drugs like Amlodepine, Atenolol, and Enalapril occupy a large
proportion of the prescription. It was however noted that though the use of the older drugs

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like diuretics as a first line therapy was present but in very less proportion. Multiple drugs
were often used to control the stage II HTN and the combination of amlodepine (CCB) and
atenolol (BB) was extensively used. Some of the newer drugs like Losartan and Lisinopril
were also found to be in use at rapid pace. The study also revealed that the effectiveness of
the therapy is independent of the use of the class of the drug.
The hospitals were more inclined to follow the BHSG while prescribing for the treatment of
essential HTN.
RECOMMENDATIONS:
All members of the health care team (e.g., physicians, nurse case managers, and other nurses,
physician assistants, pharmacists, dentists, registered dietitians,) must work together to
influence and reinforce instructions to improve patients lifestyles and BP control.
The cost of medications and the complexity of care (i.e., transportation, patient
difficulty with polypharmacy, difficulty in scheduling appointments, and lifes
competing demands) are barriers that must be overcome to achieve goal BP.
In most, if not all, hypertensive patients, therapy should be started gradually, and
target blood pressure values achieved progressively through several weeks.
To reach target blood pressure, it is likely that a large proportion of patients will
require combination therapy with more than one agent.
According to the baseline blood pressure and the presence or absence of
complications, it appears reasonable to initiate therapy either with a low dose of a
single agent or with a low-dose combination of two agents.
The major classes of antihypertensive agents diuretics, -blockers, calcium
antagonists, ACE inhibitors, and angiotensin receptor antagonists are suitable for the
initiation and maintenance of therapy.
Emphasis on identifying the first class of drugs to be used is probably outdated by the
need to use two or more drugs in combination in order to achieve goal blood pressure.
Apart from the use of drugs for the control of BP, patients should be highly motivated
to apply life style modifications, which should continue even if the patient is taking
anti hypertensive agent
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Hypertension, Vol. 9(4), Supplement 1, 170A.

Fig-1: Overall Use of AHAs

Overall use of AHAs
ARB
ACEI
AHA

9%

19.80%

54%

BB

67%

CCB
DIURETICS
0%

PERCENT

28%

20%

40%

60%

80%

.
10

KATHMANDU UNIVERSITY JOURNAL OF SCIENCE, ENGINEERING AND TECHNOLOGY

[Link], No.1, FEBRUARY, 2006.

Fig-2: Drug use in Monotherapy

AHAs used in monotherapy
45.4

50
45
40
35

25.8

30

% 25

16.7

20
15
10

7.6

4.5

Percent

5
0
diuretic

calcium
beta
ace
ace
channel blockers inhibitors receptor
blockers
blockers

AHA

Table- 1: Proportion of individual drugs used

Class of
AHA
CCB
Diuretics
BB
ARB
ACEI

INDIVIDUAL DRUGS
amlodepine
Nefedipine
Hydrochlorthiazide
frusemide+spironolactone
atenolol
Metoprolol
losartan
enalapril
Lisinopril

%
97.14
2.86
88.63
11.36
97.6
2.4
100
96.77
3.23

Table-2: Therapy Received vs. control

BP status

Monotherapy
%(Number)

Combination therapy
%(Number)

Controlled

40.8(51)

59.2(74)

Uncontrolled 48.4(15)

51.6(16)

.
11

KATHMANDU UNIVERSITY JOURNAL OF SCIENCE, ENGINEERING AND TECHNOLOGY

[Link], No.1, FEBRUARY, 2006.

Fig 3: Two drug combinations

Use of two drugs combination

others

3.3

amlodepine+diuretic

21.66

atenolol+losartan

3.3

atenolol+enalapril

Series3

atenolol+diuretic

8.3

Amlodepine+enalapril

8.3

amlodepine+atenolol

50
0

10

20

30

40

50

60

Fig-4: Triple drug combination

Use of three drug combination
others

21.4

diuretic+amlodepine+losartan

7.14

diuretic+atenolol+enalapril

10.7

amoldepine
+atenolol+losartan

10.7

Series1

amlodepine+atenolol+Enalapril

50
0

10

20

30

40

50

60

12

KATHMANDU UNIVERSITY JOURNAL OF SCIENCE, ENGINEERING AND TECHNOLOGY

[Link], No.1, FEBRUARY, 2006.

Fig-5: Type of HTN vs. Therapy

Type of HTN [Link] used

67.0
70%
60%
50%
%

60.0

55.6
44.4

40.0

33.0

40%
30%

mono

20%

combination

10%
0%
stage1

stage 2

isolated systolic
hypertension
grade 2

type of HTN

Table-3: Type of HTN vs. Therapy

Type of HTN
Stage1
Stage 2
Isolated systolic
hypertension

THERAPY
Mono%(n)
55.60%(35)
33%(29)

Combination%(n)
44.40%(28)
67%(59)

40%(2)

60%(3)

13