Abstract:
Hypertension is a major risk factor for the development and mortality of cardiovascular
diseases, representing a significant public health issue both locally and
globally. Its prevalence is increasing in Sri Lanka due to aging, urbanization, and
lifestyle factors. To improve treatment outcomes and promote rational drug use, it
is essential to evaluate prescribing patterns and the associated costs of antihypertensive
medications in the public healthcare system. This study aimed to assess
the prescribing patterns and treatment costs of antihypertensive medications in
selected secondary healthcare facilities in Galle District. A hospital-based retrospective
cross-sectional study was conducted in three randomly selected hospitals.
Primary data were collected from patient interviews and records using structured
data collection forms and analyzed using SPSS. Descriptive and inferential statistics,
including the Chi-square test, were employed. A total of 349 hypertensive
patients from Balapitiya (n=144), Elpitiya (n=148), and Unawatuna (n=57)
hospitals were included. Antihypertensive medications were categorized into six
classes, with Angiotensin II Receptor Blockers—mainly Losartan (72.20%)—being
most frequently prescribed, followed by Beta Blockers (35.50%), Calcium Channel
Blockers (33.20%), Diuretics (31.20%), Alpha Blockers (13.20%), and ACE
inhibitors (11.50%). The mean monthly cost per patient was LKR 373.97, and
affordability perceptions were positively correlated with income (p < 0.05). Drug
availability varied (ARB/Diuretics: 100.0%, ACEi/BB:97.5%, CCB:84.5%, AB:
0.0%), occasionally requiring patients to purchase medications privately. Prescribing
practices adhered 100% to national guidelines, with elderly patients (geq65
years) preferentially receiving ARBs. Monotherapy was prescribed in 53.3% of
patients, dual therapy in 33.8%, and polytherapy in 12.6%, resulting in an overall
polypharmacy prevalence of 53%. In conclusion, prescribing patterns in secondary
care hospitals in Galle District largely aligned with national and international
guidelines. Regular monitoring and the promotion of cost-effective medications
may enhance rational drug use and reduce healthcare expenditures.
