Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the Management of Hypertension : A Paper Based Questionnaire Survey.
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Date
2015-01
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Abstract
Hypertension is a prevalent condition.
Improving blood pressure control would depend on
understanding concerns and limitations of physicians.
Objective: Understanding practice of calcium channel
blockers use among physicians. Material and methods: A
cross-sectional, observational paper based questionnaire
survey among 218 Indian physicians. Results: According
to 55.83% of physicians (n=218), prevalence of
hypertension ranges between 21-40%. Sixty percent
physicians get referred cases mostly from the general
physicians (69.48%). More than 20% patients have
concomitant illness according to 33.81% physicians, most
common being diabetes (33.44%).According to 96.30%
physicians, due to asymptomatic nature, hypertension
remains undiagnosed, untreated and uncontrolled. Stress
(32.35%), obesity (23.13%), physical inactivity (22.78%)
and smoking (20.52%) are responsible for sympathetic over
activity. Calcium channel blockers (CCBs) (37.19%), beta
blockers (30.43%), angiotensin receptor blocker (ARB)
(12.14%) and angiotensin converting enzyme (ACE)
inhibitors (4.02%) are used as first choice in patients with
sympathetic over activity. Ischemic event, stroke, heart
failure and renal failure occur due to ignoring sympathetic
over activity according to 30.91%, 25.39%, 20.97% and
22.30% physicians respectively. According to 51.63% of
physicians, patient compliance to antihypertensive therapy
is > 70%. Lack of awareness (40.5%) and dosage
frequency (24%) are two most common reasons for noncompliance.
According to 89.72% of physicians, the current
CCBs primarily inhibit L-type calcium channels but cause
sympathetic over activity. A total of 48.34% physicians,
>10% patients complain of pedal edema with amlodipine.
In physicians opinion, blockage of L and N type of calcium
channels (56.47%), unique mode of action (11.76%),
arteriolar and venous dilation (9.41%) and inhibition of reninangiotensin-
aldosterone (RAS) system (7.06%) are
responsible for less pedal edema with cilnidipine. A total of
98.7% and 99.54% physicians rated efficacy and safety of
cilnidipine as “good-very good” compared to other CCB
respectively. Conclusion: In hypertension, sympathetic over
activity may cause many complications. As per the
physicians opinion survey, cilnidipine because of its unique
mechanism of action offers multiple benefits in hypertensive
patients and can be preferred over amlodipine.
Description
Keywords
hypertension, sympathetic over activity, physicians based questionnaire survey, Questionnaires, cilnidipine
Citation
Dalvi Kalpesh, Patel Kamlesh, Trailokya Abhijit. Practice of Indian Physicians Towards Use of Calcium Channel Blockers in the Management of Hypertension : A Paper Based Questionnaire Survey. Indian Medical Gazette. 2015 Jan ; 149 (1): 34-39.