VCOM Research Day Program Book 2023

Medical Student Research Publ ic Health

03 A Comparison of the Most Frequent Anti-Hypertension Drug Classes Prescribed for the Treatment of Essential Hypertension Between United States and International VCOM Clinical Sites

A. Terschueren, OMS III; K. Daller, OMS III; L. Rosario, MS-III, T.J. McCann, PhD, MPH Corresponding author: aterschueren@vt.vcom.edu

Edward Via College of Osteopathic Medicine-Virginia Campus Instituto Tecnológico de Santo Domingo (Intec) Context: Hypertension is a leading cause of cardiovascular morbidity and mortality worldwide. According to the World Health Organization (WHO), this is of significant importance because 54% of strokes and 47% of cases of ischemic heart disease are directly caused by hypertension. Thus, it is critical to normalize blood pressure with pharmacological methods in order to decrease associated morbidities and related target organ damage. This study expanded on previous studies which compared anti-hypertensive medication in developed European nations, whereas the aim for this study is to compare prescribing patterns between the United States and developing countries. Objective: The aim of this study was to determine if pharmacological treatment regimens for hypertension by drug class were associated between Edward Via College of Osteopathic Medicine (VCOM) clinical sites in the United States, Honduras, Dominican Republic, and El Salvador. Methods: The Clinical Rotation Evaluation and Documentation Organizer (CREDO) Learning System was used to collect data on patients with Essential Hypertension using the I10 ICD code at primary care clinics in El Salvador, Dominican

Republic, and Honduras sponsored by VCOM; as well as clinical sites where VCOM third- and fourth-year students rotate in the United States. The 2021 WHO recommendation of drug classes to be used as first line agents were the anti-hypertensive drug classes that were of interest. Data were exported into Excel and pregnant patients, patients with diabetes, and patients aged 44 years old and under were excluded from the study. The data were normalized across each country per 1,000 patients being treated for hypertension and the four most prescribed drug classes were compared. A Chi-Square test of independence was performed to determine if there was a significant relationship between pharmacological drug classes for treatment of hypertension. Results: In the United States and Honduras, Angiotensin-converting enzyme (ACE) inhibitors were the most prescribed anti-hypertensive class with 311 and 274 per 1,000 patients prescribed, respectively. In the Dominican Republic and El Salvador, Calcium Channel Blockers (CCBs) were the most prescribed drug class accounting for 460 and 388 patients per 1,000 patients, respectively. The observed Chi-Square test statistic was found to be 191.01, p = <.00001 and was statistically significant at the 0.01 level.

Conclusion: Variation in the most frequently prescribed anti-hypertensive medications were noted between the four countries. These patterns could potentially be explained by varying medication cost, accessibility, adverse effects of medications, and other country-specific guidelines. Further studies are warranted to assess the reasons for these differences and if they are associated with clinically important changes in morbidity and mortality.

156