To evaluate the use of various cardioprotective medicines and to document the use of different pharmacological providers within the large class of medicines, utilized for secondary prevention in CHD individuals, we performed a cross sectional study. 2.?Methods The study was approved by the institutional ethics committee. inhibitors 1196 (52.2%), ARBs 712 (31.1%), ACE inhibitors C ARB mixtures 19 (0.8%), either ACE inhibitors or ARBs 1908 (83.3%), CCBs 1023 (44.7%), statins 1457 (63.6%) and other lipid lowering providers in 170 (7.4%). Among anti-platelets aspirinCclopidogrel combination was used in 88.5%. Top three molecules in -blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB’s losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in main care ( em p /em ? ?0.01). Conclusions There is low use of -blockers, ACE inhibitors, ARBs and statins in stable CHD individuals among physicians in Rajasthan. Significant differences in use of specific molecules at primary, secondary and tertiary healthcare are observed. strong class=”kwd-title” Keywords: Evidence based medicines, Coronary heart disease, Cardiovascular pharmacology, Prescription audit 1.?Intro Patients with coronary heart disease (CHD) are at higher risk for subsequent cardiac events and mortality. A number of medicines have been shown to reduce second cardiovascular events and mortality in large randomized controlled tests.1 These are anti-platelets, -blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and cholesterol lowering statins.2 Current guidelines for the prevention of cardiovascular events among individuals with established CHD recommend anti-platelets, -blockers, ACE inhibitors and statins in all individuals.3,4 However, there is substantial space between recommendations and implementation of these medicines in program clinical practice.5 Recent studies have also demonstrated that second and third generation pharmacological agents among these cardioprotective drug classes have important pharmacological and clinical benefits. For example, metoprolol has been reported to be better than atenolol in reduction of cardiovascular events,6 perindopril and ramipril are more cardiovascular protective when compared with initial era ACE inhibitors,7,8 newer ARBs such as for example telmisartan are equal to ACE inhibitors in cardioprotective results,9 and newer statins such as for example rosuvastatin and atorvastatin possess dosing ease and much less toxicity over old statins.10,11 Research in developed countries possess reported that there takes place a substantial modification in pharmacological medication use as time passes and in addition newer substances are rapidly soaked up into practice after the clinical trial evidence emerges.12 Usage of different pharmacological agencies and, specifically, newer substances is not studied in sufferers with CHD in India. To judge the usage of different cardioprotective medicines also to document the usage of different pharmacological agencies within the wide class of medications, used for supplementary avoidance in CHD sufferers, we performed a mix sectional research. 2.?Strategies The scholarly research was approved by the institutional ethics KRas G12C inhibitor 1 committee. Information on the scholarly research process and strategies have already been reported previous.13 In short, a proforma was ready that included demographic information on sufferers, diagnoses, and medication prescriptions. Data on demographic and personal details of doctors were collected also. Physicians had been classified as major care doctors who had simple qualifications and had been employed in rural or metropolitan treatment centers and dispensaries; supplementary level doctors who had been developing a postgraduate certification in inner practising and medication separately or in federal government treatment centers, primary wellness centers or supplementary level federal government or hostipal wards; and tertiary level doctors had been people that have subspecialty certification in cardiology or cardiac medical procedures and functioning at tertiary level clinics with cardiac intrusive and surgical administration. The trade brands of drugs had been deciphered and categorized into pharmacological groupings that included aspirin, clopidogrel or various other anti-platelets agencies, -blockers, ACE ARBs or inhibitors, statins, various other lipid lowering medications such as for example fenofibrate, brief- and long-acting nitrates, dihydropyridine or nondihydropyridine calcium mineral route blockers (CCBs), potassium route openers (eg, nicorandil), metabolic modulators (eg, trimetazidine), antioxidants, multivitamins, diabetic medicines, and other medicines. The analysis was performed in any way huge districts of Rajasthan condition over an interval of 15 a few months from Sept 2007 to Dec 2008. Consent through the doctors prescribing at major, supplementary, and tertiary sites was attained as well as the prescriptions had been studied throughout a day at the neighborhood pharmacy. This is to reduce bias and negate the impact.Other factors could possibly be poor dissemination and uptake of outcomes of research data from Caucasian (non-Indian/Asian) populations, inequities in health providers, and resistance (by both doctor and individuals) to the price and complexity of prescribing multiple cardiovascular medications. atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Usage of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was even more at tertiary treatment, and atenolol, lisinopril, losartan, amlodipine and simvasatin in major treatment ( em p /em ? ?0.01). Conclusions There is certainly low usage of -blockers, ACE inhibitors, ARBs and statins in steady CHD sufferers among doctors in Rajasthan. Significant distinctions used of specific substances at primary, supplementary and tertiary health care are observed. solid course=”kwd-title” Keywords: Proof based medicines, Cardiovascular system disease, Cardiovascular pharmacology, Prescription audit 1.?Launch Patients with cardiovascular system disease (CHD) are in higher risk for subsequent cardiac occasions and mortality. Several drugs have already been shown to decrease second cardiovascular occasions and mortality in huge randomized controlled studies.1 They are anti-platelets, -blockers, angiotensin converting KRas G12C inhibitor 1 enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and cholesterol decreasing statins.2 Current guidelines for preventing cardiovascular occasions among people with established CHD recommend anti-platelets, -blockers, ACE inhibitors and statins in every individuals.3,4 However, there is certainly substantial distance between suggestions and implementation of the medicines in schedule clinical practice.5 Recent research have also proven that further and third generation pharmacological agents among these cardioprotective medicine classes possess important pharmacological and clinical benefits. For instance, metoprolol continues to be reported to become much better than atenolol in reduced amount of cardiovascular occasions,6 ramipril and perindopril are even more cardiovascular protective as compared to first generation ACE inhibitors,7,8 newer ARBs such as telmisartan are equivalent to ACE inhibitors in cardioprotective effects,9 and newer statins such as atorvastatin and rosuvastatin have dosing ease and less toxicity over older statins.10,11 Studies in developed countries have reported that there occurs a substantial change in pharmacological drug use over time and also newer molecules are rapidly absorbed into practice once the clinical trial evidence emerges.12 Use of different pharmacological agents and, specifically, newer molecules has not been studied in patients with CHD in India. To evaluate the use of various cardioprotective medicines and to document the use of different pharmacological agents within the broad class of drugs, used for secondary prevention in CHD patients, we performed a cross sectional study. 2.?Methods The study was approved by the institutional ethics committee. Details of the study protocol and methods have been reported earlier.13 In brief, a proforma was prepared that included demographic details of patients, diagnoses, and drug prescriptions. Data on demographic and personal detail of physicians were also collected. Physicians were classified as primary care physicians who had basic qualifications and were working in rural or urban clinics and dispensaries; secondary level physicians who were having a postgraduate qualification in internal medicine and practising independently or in government clinics, primary health centers or secondary level government or private hospitals; and tertiary level physicians were those with subspecialty qualification in cardiology or cardiac surgery and working at tertiary level hospitals with cardiac invasive and surgical management. The trade names of drugs were deciphered and classified into pharmacological groups that included aspirin, clopidogrel or other anti-platelets agents, -blockers, ACE inhibitors or ARBs, statins, other lipid lowering medicines such as fenofibrate, short- and long-acting nitrates, dihydropyridine or nondihydropyridine calcium channel blockers (CCBs), potassium channel openers (eg, nicorandil), metabolic modulators (eg, trimetazidine), antioxidants, multivitamins, diabetic medications, and other medications. The study was performed at all large districts of Rajasthan state over a period of 15 months from September 2007 to December 2008. Consent from the physicians prescribing at primary, secondary, and tertiary sites was obtained and the prescriptions were studied during a single day at the local pharmacy. This was to minimize bias and negate the influence of changing the prescribing habit once awareness of monitoring was apparent. We could evaluate prescriptions of 43 general practitioners or primary care physicians, 61 internists and 8 diabetologists or secondary care physicians, and 18 cardiologists in tertiary care. Interviews were organized with the individuals after their consent and only those individuals who had an established analysis of CHD were included. Approximately, 60% of qualified individuals (3013/5000) recruited from your outpatient clinics of primary, secondary, and tertiary healthcare facilities or tertiary care hospitals agreed to provide details of prescriptions. Twenty prescriptions were illegible and 2993 were included in.There is low use of -blockers, ACE inhibitors and statins. 1196 (52.2%), ARBs 712 (31.1%), ACE inhibitors C ARB mixtures 19 (0.8%), either ACE inhibitors or ARBs 1908 (83.3%), CCBs 1023 (44.7%), statins 1457 (63.6%) and other lipid lowering providers in 170 (7.4%). Among anti-platelets aspirinCclopidogrel combination was used in 88.5%. Top three molecules in -blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB’s losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in main care ( em p /em ? ?0.01). Conclusions There is low use of -blockers, ACE inhibitors, ARBs and statins in stable CHD individuals among physicians in Rajasthan. Significant variations in use of specific molecules at primary, secondary and tertiary healthcare are observed. strong class=”kwd-title” Keywords: Evidence based medicines, Coronary heart disease, Cardiovascular pharmacology, Prescription audit 1.?Intro Patients with coronary heart disease (CHD) are at higher risk for subsequent cardiac events and mortality. A number of drugs have been shown to reduce second cardiovascular events and mortality in large randomized controlled tests.1 These are anti-platelets, -blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and cholesterol lowering statins.2 Current guidelines for the prevention of cardiovascular events among individuals with established CHD recommend anti-platelets, -blockers, ACE inhibitors and statins in all individuals.3,4 However, there is substantial space between recommendations and implementation of these medicines in program clinical practice.5 Recent studies have also demonstrated that second and third generation pharmacological agents among these cardioprotective drug classes have important pharmacological and clinical benefits. For example, metoprolol has been reported to be better than atenolol in reduction of cardiovascular events,6 ramipril and perindopril are more cardiovascular protective as compared to first generation ACE inhibitors,7,8 newer ARBs such as telmisartan are equivalent to ACE inhibitors in cardioprotective effects,9 and newer statins such as atorvastatin and rosuvastatin have dosing simplicity and less toxicity over older statins.10,11 Studies in developed countries have reported that there occurs a substantial switch in pharmacological drug use over time and also newer molecules are rapidly absorbed into practice once the clinical trial evidence emerges.12 Use of different pharmacological providers and, specifically, newer molecules has not been studied in individuals with CHD in India. To evaluate the use of numerous cardioprotective medicines and to document the use of different pharmacological providers within the broad class of medicines, used for secondary prevention in CHD individuals, we performed a cross sectional study. 2.?Methods The analysis was approved by the institutional ethics committee. Information on the study process and methods have already been reported previous.13 In short, a proforma was ready that included demographic information on sufferers, diagnoses, and medication prescriptions. Data on demographic and personal details of physicians had been also collected. Doctors had been classified as principal care doctors who had simple qualifications and had been employed in rural or metropolitan treatment centers and dispensaries; supplementary level physicians who had been developing a postgraduate certification in internal medication and practising separately or in federal government clinics, primary wellness centers or supplementary level federal government or hostipal wards; and tertiary level doctors had been people that have subspecialty certification in cardiology or cardiac medical procedures and functioning at tertiary level clinics with cardiac intrusive and surgical administration. The trade brands of drugs had been deciphered and categorized into pharmacological groupings that included aspirin, clopidogrel or various other anti-platelets agencies, -blockers, ACE inhibitors or ARBs, statins, various other lipid lowering medications such as for example fenofibrate, brief- and long-acting nitrates, dihydropyridine or nondihydropyridine calcium mineral route blockers (CCBs), potassium route openers (eg, nicorandil), metabolic modulators (eg, trimetazidine), antioxidants, multivitamins, diabetic medicines, and other medicines. The analysis was performed in any way huge districts of Rajasthan condition over an interval of 15 a few months from Sept 2007 to Dec 2008. Consent in the doctors prescribing at principal, supplementary, and tertiary sites was attained as well as the prescriptions had been studied throughout a day at the neighborhood pharmacy. This is to reduce bias and negate the impact of changing the prescribing habit once knowing of monitoring was obvious. We could assess prescriptions of 43 general professionals or primary treatment doctors, 61 internists and 8 diabetologists or supplementary care doctors, and 18 KRas G12C inhibitor 1 cardiologists in tertiary treatment. Interviews had been organized using the sufferers after their consent in support of those sufferers who had a recognised medical diagnosis of CHD had been included. Around, 60% of entitled sufferers (3013/5000) recruited in the.Usage of metoprolol, ramipril, valsartan, atorvastatin and diltiazem was more in tertiary treatment even though in principal treatment atenolol, lisinopril, losartan, amlodipine and simvasatin make use of was more (2 check for inter-group difference, em p /em ? ?0.01). Table 2 Cardiovascular drug use at principal, supplementary, and tertiary healthcare. thead th rowspan=”1″ colspan=”1″ Substances utilized /th th rowspan=”1″ colspan=”1″ Principal treatment (297) /th th rowspan=”1″ colspan=”1″ Supplementary treatment (1484) /th th rowspan=”1″ colspan=”1″ Tertiary treatment (509) /th th rowspan=”1″ colspan=”1″ em X /em 2 ( em p /em -worth) /th /thead Anti-platelets ( em n /em ?=?2031)?Aspirin48 (24.7)162 (11.9)24 (5.0)0.0001?AspirinCclopidogrel146 (75.2)1192 (88.0)459 (95.0)0.0001-Blockers ( em /em n ?=?1494)?Atenolol84 (41.2)366 (39.3)116 (32.2)0.21?Metoprolol27 (13.2)249 (26.8)118 (32.7)0.0001?Carvedilol17 (8.3)120 (12.9)41 (11.4)0.36?Bisoprolol23 (11.3)89 (9.5)27 (7.5)0.36?Nebivolol8 (3.9)53 (5.7)47 (13.0)0.0001?Propanolol23 (11.3)43 (4.6)8 (2.2)0.0001?Others22 (10.8)10 (1.1)3 (0.8)0.0001Angiotensin converting enzyme inhibitors ( em /em n ?=?1196)?Ramipril34 (24.8)289 (38.2)181 (59.9)0.0001?Lisnopril36 (26.3)170 (22.5)34 (11.2)0.0006?Perindopril3 (2.2)79 (10.4)51 (16.9)0.0001?Enalapril33 (24.1)98 (12.9)16 (5.3)0.0001?Captopril23 (16.8)61 (8.1)3 (0.9)0.0001?Trandolapril4 (2.9)38 (5.0)12 (4.0)0.0001?Others4 (2.9)21 (2.8)5 (1.6)0.54Angiotensin receptors blockers ( em /em n ?=?712)?Losartan40 (54.7)249 (48.6)51 (40.1)0.0008?Valsartan9 (12.3)117 (22.8)33 (26.0)0.009?Telmisartan8 (10.9)69 (13.5)29 (22.8)0.14?Candesartan14 (19.1)50 (9.7)6 (4.7)0.009?Others2 (2.7)27 (5.3)8 (6.3)0.35Calcium route blockers ( em /em ?=?1023)?Amlodipine106 (61.6)321 (46.5)56 (35.0)0.0001?Diltiazem27 (15.7)206 (29.9)65 (40.6)0.08?Verapamil8 (4.6)67 (9.7)22 (13.7)0.36?Nifedipine11 (6.4)33 (4.8)2 (1.2)0.003?Felodipine12 (6.9)33 (4.8)2 (1.2)0.001?Nicardipine2 (1.1)9 (1.3)12 (7.5)0.002?Others6 (3.5)20 (2.9)1 (0.6)0.04Statins ( em n /em ?=?1457)?Atorvastatin27 (40.9)478 (50.7)221 (52.3)0.0001?Simvastatin35 (53.0)283 (30.0)104 (24.6)0.0053?Rosuvastatin3 (5.3)157 (16.6)76 (18.0)0.0001?Others1 (1.7)25 (2.6)21 (5.0)0.0003Other lipid lowering drugs ( em n /em ?=?170)?Fibrates2 (66.7)47 (42.3)22 (39.3)0.01?Niacin0 (0.0)24 (21.6)5 (8.9)0.06?Orlistat0 (0.0)30 (27.0)5 (8.9)0.01?Others1 (33.3)10 (9.0)24 (42.8)0.0001 Open in a separate window 4.?Discussion This study shows a substantial under-prescribing of cardiovascular evidence based medications in stable community dwelling patients with CHD. (7.4%). Among anti-platelets aspirinCclopidogrel combination was used in 88.5%. Top three molecules in -blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB’s losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in primary care ( em p /em ? ?0.01). Conclusions There is low use of -blockers, ACE inhibitors, ARBs and statins in stable CHD patients among physicians in Rajasthan. Significant differences in use of specific molecules at primary, secondary and tertiary healthcare are observed. strong class=”kwd-title” Keywords: Evidence based medicines, Coronary heart disease, Cardiovascular pharmacology, Prescription audit 1.?Introduction Patients with coronary heart disease (CHD) are at higher risk for subsequent cardiac events and mortality. A number of drugs have been shown to reduce second cardiovascular events and mortality in large randomized controlled trials.1 These are anti-platelets, -blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and cholesterol lowering statins.2 Current guidelines for the prevention of cardiovascular events among individuals with established CHD recommend anti-platelets, -blockers, ACE inhibitors and statins in all individuals.3,4 However, there is substantial gap between recommendations and implementation of these medicines in routine clinical practice.5 Recent studies have also shown that second and third generation pharmacological agents among these cardioprotective drug classes have important pharmacological and clinical benefits. For example, metoprolol has been reported KRas G12C inhibitor 1 to be better than atenolol in reduction of cardiovascular events,6 ramipril and perindopril are more cardiovascular protective as compared to first generation ACE inhibitors,7,8 newer ARBs such as telmisartan are equivalent to ACE inhibitors in cardioprotective effects,9 and newer statins such as atorvastatin and rosuvastatin have dosing ease and less toxicity over older statins.10,11 Studies in developed countries have reported that there occurs a substantial change in pharmacological drug use over time and also newer molecules are rapidly absorbed into practice once the clinical trial evidence emerges.12 Use of different pharmacological brokers and, specifically, newer molecules has not been studied in patients with CHD in India. To evaluate the use of various cardioprotective medicines and to document the use of different pharmacological brokers within the broad class of drugs, used for secondary prevention in CHD patients, we performed a cross sectional study. 2.?Methods The study was approved by the institutional ethics committee. Details of the study protocol and methods have been reported earlier.13 In brief, a proforma was prepared that included demographic details of patients, diagnoses, and drug prescriptions. Data on demographic and personal detail of physicians were also collected. Physicians were classified as primary care physicians who had basic qualifications and were working in rural or urban clinics and dispensaries; secondary level physicians who were having a postgraduate qualification in internal medicine and practising independently or in government clinics, primary health centers or secondary level government or private hospitals; and tertiary level physicians were those with subspecialty qualification in cardiology or cardiac surgery and working at tertiary level hospitals with cardiac invasive and surgical management. The trade names of drugs were deciphered and classified into pharmacological groups that included aspirin, clopidogrel or other anti-platelets agents, -blockers, ACE inhibitors or ARBs, statins, other lipid lowering medicines such as fenofibrate, short- and long-acting nitrates, dihydropyridine or nondihydropyridine calcium channel blockers (CCBs), potassium channel openers (eg, nicorandil), metabolic modulators (eg, trimetazidine), antioxidants, multivitamins, diabetic medications, and other medications. The study was performed at all large districts of Rajasthan state over a period of 15 months from September 2007 to December 2008. Consent from the physicians prescribing at primary, secondary, and tertiary sites was obtained and the prescriptions were studied during a single day at the local pharmacy. This was to.The lowest use is at the primary care level as reported earlier.13 Dual anti-platelet therapy is widely used. (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in primary care ( em p /em ? ?0.01). Conclusions There is low use of -blockers, ACE inhibitors, ARBs and statins in stable CHD patients among physicians in Rajasthan. Significant differences in use of specific molecules at primary, secondary and tertiary healthcare are observed. strong class=”kwd-title” Keywords: Evidence based medicines, Coronary heart disease, Cardiovascular pharmacology, Prescription audit 1.?Introduction Patients with coronary heart disease (CHD) are at higher risk for subsequent cardiac events KRas G12C inhibitor 1 and mortality. A number of drugs have been shown to reduce second cardiovascular events and mortality in large randomized controlled trials.1 These are anti-platelets, -blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and cholesterol lowering statins.2 Current guidelines for the prevention of cardiovascular events among individuals with established CHD recommend anti-platelets, -blockers, ACE inhibitors and statins in all individuals.3,4 However, there is substantial gap between recommendations and implementation of these medicines in routine clinical practice.5 Recent studies have also shown that second and third generation pharmacological agents among these cardioprotective drug classes have important pharmacological and clinical benefits. For example, metoprolol has been reported to be better than atenolol in reduction of cardiovascular events,6 ramipril and perindopril are more cardiovascular protective as compared to first generation ACE inhibitors,7,8 newer ARBs such as telmisartan are equivalent to ACE inhibitors in cardioprotective effects,9 and newer statins such as atorvastatin and rosuvastatin have dosing ease and less toxicity over older statins.10,11 Studies in developed countries have reported that there occurs a substantial switch in pharmacological drug use over time and also newer molecules MPSL1 are rapidly absorbed into practice once the clinical trial evidence emerges.12 Use of different pharmacological providers and, specifically, newer molecules has not been studied in individuals with CHD in India. To evaluate the use of numerous cardioprotective medicines and to document the use of different pharmacological providers within the broad class of medicines, used for secondary prevention in CHD individuals, we performed a cross sectional study. 2.?Methods The study was approved by the institutional ethics committee. Details of the study protocol and methods have been reported earlier.13 In brief, a proforma was prepared that included demographic details of individuals, diagnoses, and drug prescriptions. Data on demographic and personal fine detail of physicians were also collected. Physicians were classified as main care physicians who had fundamental qualifications and were working in rural or urban clinics and dispensaries; secondary level physicians who have been possessing a postgraduate qualification in internal medicine and practising individually or in authorities clinics, primary health centers or secondary level authorities or private hospitals; and tertiary level physicians were those with subspecialty qualification in cardiology or cardiac surgery and operating at tertiary level private hospitals with cardiac invasive and surgical management. The trade titles of drugs were deciphered and classified into pharmacological organizations that included aspirin, clopidogrel or additional anti-platelets providers, -blockers, ACE inhibitors or ARBs, statins, additional lipid lowering medicines such as fenofibrate, short- and long-acting nitrates, dihydropyridine or nondihydropyridine calcium channel blockers (CCBs), potassium channel openers (eg, nicorandil), metabolic modulators (eg, trimetazidine), antioxidants, multivitamins, diabetic medications, and other medications. The study was performed whatsoever large districts of Rajasthan state over a period of 15 weeks from September 2007 to December 2008. Consent from your physicians prescribing at main, secondary, and tertiary sites was acquired and the prescriptions were studied during a single day at the local pharmacy. This was to minimize bias and negate the influence of changing the prescribing habit once awareness of monitoring was apparent..
