Diabetes mellitus

Waleed Sweileh's picture

Evaluation of Antihypertensive Therapy In Diabetic Hypertensive Patients: Impact of Ischemic Heart Disease

Journal Title, Volume, Page: 
Pharmacy Practice (Internet), ISSN 1886-3655, Vol. 7, Nº. 1, 2009, pags. 40-46 01/2009; DOI: 10.4321/S1886-36552009000100006
Year of Publication: 
2009
Authors: 
Waleed M Sweileh
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Ansam F Sawalha
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Saed H. Zyoud
Poison Control and Drug Information Center (PCDIC). An-Najah National University. Nablus (Palestine)
Samah W. Al-Javi
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Eman J. Tameem
Poison Control and Drug Information Center (PCDIC). An-Najah National University. Nablus (Palestine)
Nasr Y. Shraim
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population. RESUMEN Las complicaciones macrovasculares son frecuentes en pacientes diabéticos hipertensos. Se cree que un apropiado tratamiento antihipertensivo y un control estrecho de la presión arterial previenen o retrasan estas complicaciones. Objetivo: Evaluar los patrones de utilización de antihipertensivos y el control de la presión arterial (PA) en pacientes diabéticos hipertensos con y sin enfermedad isquémica cardiaca (EIC). Métodos: Estudio de cohorte retrospectivo de todos los pacientes diabéticos hipertensos que acudieron al centro médico Al-watani desde agosto 2006 a agosto 2007. Se compararon las proporciones de pacientes que recibían 1,2,3 o 4 o más medicamentos, y por separado los pacientes con y sin EIC. El control de presión arterial (menor o igual a 130/80 mmHg) se comparó en los pacientes recibiendo ningún tratamiento, monoterapia o tratamiento de combinación y por separado los que tenían o no EIC. Resultados: Se incluyeron en el estudio 255 pacientes; su media de edad era de 64,4 (DE=11,4) años. Sesenta y uno (23,9%) de los pacientes incluidos estaban en la presión arterial deseada. Más del 60% del total recibían inhibidores de la enzima convertidor de la angiotensina (IECA)/Antagonistas del receptor de angiotensina (ARA), seguidos de diuréticos (40,8%), bloqueantes de canales de calcio (25,1%), y betabloqueantes (12,5%). La mayoría (más del 55%) estaban en monoterapia o sin tratamiento. Más del 55% de los pacientes con la PA controlada utilizaban IECA. Más de la mitad (50,8%) de los pacientes con la PA controlada estaban con tratamiento de combinación, mientras que el 42,3% de los pacientes con PA descontrolada estaban con tratamiento combinado (p=0,24). Alcanzaron la PA deseada más pacientes del grupo EIC que del grupo no-EIC (p=0,019). La comparación entre los grupos EIC y no-EIC indicó que no había diferencia significativa en la utilización de ningún grupo de medicamentos con los IECA, siendo estos los más utilizados en los dos grupos. Conclusión: Los patrones de utilización de antihipertensivos fueron generalmente no consistentes con las recomendaciones internacionales. Las posibles mejoras incluyen aumentar las combinaciones de los IECA, disminuir la proporciona de pacientes no tratados, y aumentar la proporción de pacientes con PA controlada en esta población.

Iyad Ali's picture

Diabetes Mellitus in Patients with Schizophrenia in West-Bank, Palestine

Journal Title, Volume, Page: 
Diabetes Research and Clinical Practice Volume 99, Issue 3, March 2013, Pages 351–357
Year of Publication: 
2013
Authors: 
Waleed M. Sweileh
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Salah A. Dalal
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Samah W. Al-Jabi
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Iyad Al-Ali
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Aims The main aims of the study were to investigate the prevalence of pre-diabetes and diabetes mellitus (DM) in patients with schizophrenia, to compare it with those published in the general population, and to assess significant associations with dysglycemia defined as having either pre-DM or DM.
Methods A cross-sectional study carried out in 4 governmental primary psychiatric healthcare centers in Northern West-Bank, Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured. The World Health Organization (WHO) criteria for defining pre-DM and DM were used. Dysglycemia was defined as FBG >110 mg/dl.
Results Based on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had pre-diabetes. The prevalence of DM in patients with schizophrenia was not significantly higher than that reported in the general population of Palestine. However, the prevalence of pre-DM was significantly higher than that reported in the general population of Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant predictors of dysglycemia in patients with schizophrenia.
Conclusions This study confirmed the high prevalence of dysglycemia in patients with schizophrenia, supporting the need for monitoring of blood glucose in this category of patients. The presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drugs.  

Waleed Sweileh's picture

Diabetes Mellitus Type 2 is Not a Risk Factor for Aminoglycoside Induced Renal Injury

Journal Title, Volume, Page: 
Diabetologia Croatica 40-1
Year of Publication: 
2011
Authors: 
Waleed M. Sweileh
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Ansam F. Sawalha
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Adham S. Abu-Taha
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 
The aim of the study was to investigate the extent and time course of aminoglycoside (AG)-induced serum creatinine elevation in patients with and without type 2 diabetes mellitus (DM2). This prospective study included patients with and without DM2 who were administered AG parenterally. The outcome of interest was the extent and time course of serum creatinine elevation suggestive of renal injury during AG therapy. Data were entered and analyzed using a statistical package for social sciences (SPSS 16). Of 94 patients included in the study, there were 42 DM2 and 52 non-DM2 patients. There was no significant between-group difference in initial (P=0.18) and final serum creatinine (P=0.15). Furthermore, no significant difference in serum creatinine elevation was observed between patients with and without DM2 during the course of AG therapy. Eleven (26.2%) of 42 DM2 patients and 13 (25%) of 52 non-DM2 patients had an increase of ?44.2 μmol/L in serum creatinine level during therapy (P=0.89). In DM2 group, a significant rise (P=0.04) in serum creatinine level was evident on day 4 and maximum rise (28%) from baseline value was evident on day 6 of therapy. Similar extent and time course of serum creatinine elevation was observed in non-DM2 group. In conclusion, type 2 diabetes mellitus is not a risk factor for aminoglycoside-induced renal injury.
Waleed Sweileh's picture

Clinical Characteristics, Sex Differences and In-Hospital Mortality Among Stroke Patients with and without Diabetes Mellitus

Journal Title, Volume, Page: 
Diabetologia Croatica, 40-2
Year of Publication: 
2011
Authors: 
Waleed M. Sweileh
College of Pharmacy, An-Najah National University, Nablus,Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
Poison Control and Drug Information Center (PCDIC), An-Najah National University, Nablus, Palestine
Ansam F. Sawalha
College of Pharmacy, An-Najah National University, Nablus,Palestine
Samah W. Al-Jabi
Poison Control and Drug Information Center (PCDIC), An-Najah National University, Nablus, Palestine
Adham S. Abu-Taha
College of Pharmacy, An-Najah National University, Nablus,Palestine
Preferred Abstract (Original): 
The aim of the study was to investigate and compare clinical characteristics, sex differences and in-hospital mortality between stroke patients with and without diabetes mellitus (DM). All patients admitted to Al- Watani Governmental Hospital for 12 consecutive months and diagnosed with acute stroke were included in the study. Demographic data, clinical characteristics and in-hospital mortality were compared between diabetic and nondiabetic stroke patients. Pearson χ2-test and Student’s t-test were used on univariate analysis. Data were analyzed using SPSS 16. There were 186 stroke patients, mean age 69.09±0.9 years, with positive DM history recorded in 48.9% of male and 45.2% of female patients. Diabetic stroke patients were significantly younger (66.8±10.99 vs. 71±10.52 years; P=0.009) and had a higher proportion of ischemic heart disease (11.9% vs. 3.9%; P=0.04) compared to nondiabetic stroke patients. Inhospital mortality accounted for 39 (21%) patients, including 23 (27.4%) diabetic and 16 (15.7%) nondiabetic stroke patients (P=0.051). Univariate analysis of diabetic stroke patients based on sex showed male patients to have significantly more hemorrhagic strokes (P=0.04), recurrent strokes (P=0.003) and in-hospital mortality (P=0.034) compared to female patients. There was no sex difference in nondiabetic stroke patients. Analysis of diabetic stroke patients based on vital status indicated that in-hospital mortality was significantly associated with sex (P=0.034), type of stroke (P=0.006) and recurrent stroke (P=0.01). None of the variables was significantly associated with mortality in nondiabetic stroke patients. In conclusion, diabetic patients have different clinical characteristics, show sex differences and in-hospital mortality differences compared to nondiabetic patients after acute stroke.
Waleed Sweileh's picture

Adherence and Satisfaction with Oral Hypoglycemic Medications: A Pilot Study in Palestine

Journal Title, Volume, Page: 
International journal of clinical pharmacy, Volume 33, Issue 6, pp 942-948
Year of Publication: 
2011
Authors: 
Waleed M. Sweileh
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Raniah M. Jamous
Clinical Pharmacy, Palestinian Military Medical Services, Nablus, Palestine
Adham S. Abu-Taha
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Ansam F. Sawalha
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), 11800 Penang, Malaysia
Donald E. Morisky
Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA
Preferred Abstract (Original): 

OBJECTIVES:

Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. Few studies on medication adherence have been published from the Arab countries. Therefore, the objective of this pilot study was to assess hypoglycemic medication adherence and its association with treatment satisfaction.

SETTING:

Military Medical Services clinic in Nablus, Palestine.

METHODS:

This is a cross sectional descriptive study. A convenience sample of 131 diabetic patients was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Questionnaire for Medication were used to assess adherence and treatment satisfaction, respectively. Statistical Package for Social Sciences was used for statistical analysis.

MAIN OUTCOME MEASURE:

Level of adherence, treatment satisfaction and association between adherence and treatment satisfaction among diabetic patients.

RESULTS:

According to MMAS-8, 50 patients (38.5%) had a high adherence, 58 (44.6%) had a medium adherence and 22 (16.9%) had a low adherence rate. The mean scores of satisfaction domains were 71 ± 17.6 and 95 ± 16.4 for effectiveness (EFF) and side effects (SE), respectively. Adherence score was a positively and significantly correlated with EFF satisfaction domain (P < 0.01) and age (P = 0.01). Similar significant correlation was found between adherence level and duration of illness (P = 0.047). However, adherence was not significantly associated with gender (P = 0.2), number of hypoglycemic medications (P = 0.5) or SE satisfaction domain (P = 0.2).

DISCUSSION AND CONCLUSION:

The majority of diabetic patients in this pilot study were non-adherent. Improving patients' treatment satisfaction will improve treatment adherence.

Waleed Sweileh's picture

Diabetes Mellitus in Patients with Schizophrenia in West-Bank, Palestine

Journal Title, Volume, Page: 
DIAB-5692, Volume 99, Issue 3, Pages 351–357
Year of Publication: 
2012
Authors: 
Waleed M. Sweileh
College of Medicine and Health Sciences, Division of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Salah A. Dalal
College of Medicine and Health Sciences, Division of Pharmacy, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
College of Medicine and Health Sciences, Division of Pharmacy, An-Najah National University, Nablus, Palestine
Samah W. Al-Jabi
College of Medicine and Health Sciences, Division of Pharmacy, An-Najah National University, Nablus, Palestine
Iyad Al-Ali
College of Medicine and Health Sciences, Division of Pharmacy, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Aims

The main aims of the study were to investigate the prevalence of pre-diabetes and diabetes mellitus (DM) in patients with schizophrenia, to compare it with those published in the general population, and to assess significant associations with dysglycemia defined as having either pre-DM or DM.

Methods

A cross-sectional study carried out in 4 governmental primary psychiatric healthcare centers in Northern West-Bank, Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured. The World Health Organization (WHO) criteria for defining pre-DM and DM were used. Dysglycemia was defined as FBG >110 mg/dl.

Results

Based on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had pre-diabetes. The prevalence of DM in patients with schizophrenia was not significantly higher than that reported in the general population of Palestine. However, the prevalence of pre-DM was significantly higher than that reported in the general population of Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant predictors of dysglycemia in patients with schizophrenia.

Conclusions

This study confirmed the high prevalence of dysglycemia in patients with schizophrenia, supporting the need for monitoring of blood glucose in this category of patients. The presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drugs.

saedzyoud's picture

Diabetes mellitus in patients with schizophrenia in West-Bank, Palestine

Journal Title, Volume, Page: 
Diabetes Research and Clinical Practice 2013 Jan 28. pii: S0168-8227(12)00512-8. doi: 10.1016/j.diabres.2012.12.014
Year of Publication: 
2013
Authors: 
Waleed M. Sweileh
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Salah A. Dalal
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Samah W. Al-Jabi
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Iyad Al-Ali
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Aims The main aims of the study were to investigate the prevalence of pre-diabetes and diabetes mellitus (DM) in patients with schizophrenia, to compare it with those published in the general population, and to assess significant associations with dysglycemia defined as having either pre-DM or DM.
Methods
A cross-sectional study carried out in 4 governmental primary psychiatric healthcare centers in Northern West-Bank, Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured. The World Health Organization (WHO) criteria for defining pre-DM and DM were used. Dysglycemia was defined as FBG >110mg/dl.
Results
Based on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had pre-diabetes. The prevalence of DM in patients with schizophrenia was not significantly higher than that reported in the general population of Palestine. However, the prevalence of pre-DM was significantly higher than that reported in the general population of Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant predictors of dysglycemia in patients with schizophrenia.
Conclusions
This study confirmed the high prevalence of dysglycemia in patients with schizophrenia, supporting the need for monitoring of blood glucose in this category of patients. The presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drugs.

ansam's picture

Adherence and Satisfaction with Oral Hypoglycemic Medications: A Pilot Study in Palestine

Journal Title, Volume, Page: 
International Journal of Clinical Pharmacy December 2011, Volume 33, Issue 6, pp 942-948
Year of Publication: 
2011
Authors: 
Ansam F. Sawalha
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
Faculty of Medicine & Health Sciences, Department of Biomedical Sciences, An-Najah National University, Nablus, Palestine
Raniah M. Jamous
Clinical Pharmacy, Palestinian Military Medical Services, Nablus, Palestine
Waleed M. Sweileh
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Adham S. Abu-Taha
Department of Pharmacology and Toxicology, School of Pharmacy, An-Najah National University, Nablus, Palestine
Sa’ed H. Zyoud
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
Donald E. Morisky
Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772, USA
Preferred Abstract (Original): 

Objectives
Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. Few studies on medication adherence have been published from the Arab countries. Therefore, the objective of this pilot study was to assess hypoglycemic medication adherence and its association with treatment satisfaction.

Setting
Military Medical Services clinic in Nablus, Palestine. 

Methods
This is a cross sectional descriptive study. A convenience sample of 131 diabetic patients was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Questionnaire for Medication were used to assess adherence and treatment satisfaction, respectively. Statistical Package for Social Sciences was used for statistical analysis.

Main
Outcome measure Level of adherence, treatment satisfaction and association between adherence and treatment satisfaction among diabetic patients.

Results
According to MMAS-8, 50 patients (38.5%) had a high adherence, 58 (44.6%) had a medium adherence and 22 (16.9%) had a low adherence rate. The mean scores of satisfaction domains were 71 ± 17.6 and 95 ± 16.4 for effectiveness (EFF) and side effects (SE), respectively. Adherence score was a positively and significantly correlated with EFF satisfaction domain (P < 0.01) and age (P = 0.01). Similar significant correlation was found between adherence level and duration of illness (P = 0.047). However, adherence was not significantly associated with gender (P = 0.2), number of hypoglycemic medications (P = 0.5) or SE satisfaction domain (P = 0.2).

Discussion and conclusion
The majority of diabetic patients in this pilot study were non-adherent. Improving patients' treatment satisfaction will improve treatment adherence.

ansam's picture

Diabetes Mellitus Type 2 is Not a Risk Factor for Aminoglycoside Induced Renal Injury

Journal Title, Volume, Page: 
Diabetologia Croatica 40-1
Year of Publication: 
2011
Authors: 
Ansam F. Sawalha
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Waleed M. Sweileh
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Adham S. Abu-Taha
Department of Pharmacology/Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 
The aim of the study was to investigate the extent and time course of aminoglycoside (AG)-induced serum creatinine elevation in patients with and without type 2 diabetes mellitus (DM2). This prospective study included patients with and without DM2 who were administered AG parenterally. The outcome of interest was the extent and time course of serum creatinine elevation suggestive of renal injury during AG therapy. Data were entered and analyzed using a statistical package for social sciences (SPSS 16). Of 94 patients included in the study, there were 42 DM2 and 52 non-DM2 patients. There was no significant between-group difference in initial (P=0.18) and final serum creatinine (P=0.15). Furthermore, no significant difference in serum creatinine elevation was observed between patients with and without DM2 during the course of AG therapy. Eleven (26.2%) of 42 DM2 patients and 13 (25%) of 52 non-DM2 patients had an increase of ?44.2 μmol/L in serum creatinine level during therapy (P=0.89). In DM2 group, a significant rise (P=0.04) in serum creatinine level was evident on day 4 and maximum rise (28%) from baseline value was evident on day 6 of therapy. Similar extent and time course of serum creatinine elevation was observed in non-DM2 group. In conclusion, type 2 diabetes mellitus is not a risk factor for aminoglycoside-induced renal injury.
Nasr SHRAIM's picture

Evaluation of Antihypertensive Therapy in Diabetic Hypertensive Patients: Impact of Ischemic Heart Disease

Journal Title, Volume, Page: 
Pharmacy Practice (Internet) 7(1):40- 46
Year of Publication: 
2009
Authors: 
Waleed Sweileh
College of Pharmacy, Clinical Pharmacy Graduate Program. An-Najah National University, Nablus, Palestine
Ansam Sawalha
College of Pharmacy, Clinical Pharmacy Graduate Program, and Poison Control and Drug Information Center (PCDIC). An-Najah National University, Nablus, Palestine
Sa'ed Zyoud
Poison Control and Drug Information Center (PCDIC). An-Najah Nati onal University. Nablus, Palestine
Samah Al-Jabi
College of Pharmacy, Clinical Pharmacy Graduate Program. An-Najah National University, Nablus, Palestine
Eman Tameem
Poison Control and Drug Information Center (PCDIC). An-Najah Nati onal University. Nablus, Palestine
Naser Shraim
College of Pharmacy, Clinical Pharmacy Graduate Program. An-Najah National University, Nablus, Palestine
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 
Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.
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