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Temporal changes in antihypertensive prescribing trend in Bahrain over a decade: emerging issues in iatrogenic sexual dysfunction.

OBJECTIVE
To elucidate temporality of antihypertensive drug prescribing trends over a decade in terms of emerging views on iatrogenic sexual dysfunctions (SD).


METHODS
The antihypertensive prescribing trend in 2007 was compared with baseline data collected in 1998 using prescription audit.


RESULTS
Angiotensin converting enzyme (ACE) inhibitors were deemed first and second ranked antihypertensives for patients with diabetic hypertension and hypertension in 2007, respectively. Between 1998 and 2007 β-blockers such as atenolol, and methyldopa use has declined in both male and female patients. In 2007, the rate of prescribing atenolol at inappropriately high doses has declined as compared to 1998, especially in males. Methyldopa overall use has declined in 2007, although it is often prescribed to females. Compared to baseline of 1998 there was a significant upturn in diuretic use. Nonetheless the trend towards prescribing indapamide ≤ 1.5 mg/day and 12.5 mg/day hydrochlorothiazide, at doses least likely to cause SD, was evident in both male and females. This trend appears to be related to the use of fixed-dose combinations (FDCs) and antihypertensive combination therapies which have significantly increased in recent years (p < 0.0001).


CONCLUSION
With respect to the prescribing rate and dose appropriateness, antihypertensives that are likely to cause SD appear to be more rationally prescribed in 2007 as compared to 1998. Introducing FDCs had an important role in resurgence of appropriate low dose of drugs implicated with SD and diuretic-based antihypertensive combination therapies.