Controlled hypertension among the Palestine refugee patient population treated by general practitioners at the UNRWA PHCs in Jordan between 2008 and 2012 . Uncontrolled hypertension was defined as a systolic/diastolic blood pressure 140/90 in 2 out of 3 readings, one of which is the most recent reading, during the treatment year. Antihypertensive medications were classified based on the World Health Organization (WHO) Anatomic Therapeutic Chemical (ATC) system which are depicted in Table 1 [10]. We also used the WHO defined daily dose (DDD) methodology, which is often used to evaluate drug utilization using aggregate data, to calculate utilization of antihypertensive medications using our procurement data. We obtained the DDD values from the WHO ATC/DDD index to Naloxegol oxalate derive DDDs for each medication. DDD is a measure that represents that average daily maintenance dose for the main indication of a drug in adults. It is used to aggregate data on different doses, strengths, and formulations to enable comparisons of PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/1669444 utilization across different medications, different populations and over time. For example, 10 DDDs/100 patients per day for a medication or class of medications indicates that 10 of the population on average receive a certain medication or group of medications daily. In our study, utilization is defined as number of DDDs per 100 persons with hypertension (patient population) per day. Our hypertension sample was based on the number of patients over the age of 40 diagnosed with hypertension at UNRWA PHCs between 2008 and 2012 (Table 2). The number of DDDs for all antihypertensive medications were aggregated and utilization was calculated for antihypertensive medications overall, by antihypertensive therapeutic category (e.g. -blockers, diuretics) and for individual antihypertensive medications (e.g. enalapril). With the exception of amiloride/hydrocholorothiazideSaadeh et al. Journal of Pharmaceutical Policy and Practice (2015) 8:Page 3 ofTable 1 Changes in the utilization (DDDs per 100 hypertensive patients per year) of antihypertensive medications among the Palestine refugee hypertensive patient population in Jordan between 2008 (pre-STG) and 2012 (post-STG)ATC codes Therapeutic class Antihypertensive utilization, Change in utilization Percent change in utilization of total 2008 Total** C02AB01 C09AA02 C09CA01 C07AA05, C07AB03 C08CA05, C08DB01, C08CA01 C03AA03,C03AX01, C03CA01,C03DB01 Alpha-adrenergic agonists ACE inhibitors** Angiotensin II receptor antagonists** Beta blockers Calcium channel blockers Diuretics** 280.5 (100 ) 2.22 (0.8 ) 178.1 (63.5 ) 0 (0 ) 53.9 (19.2 ) 23.8 (8.5 ) 22.4 (8.0 ) 2012 275.3(100 ) 2.55 (0.9 ) 132.5 (48.1 ) 7.7 (2.8 ) 55.4 (20.1 PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/7766718 ) 26.97 (9.8 ) 50.2 (18.2 ) 2008-2012 -5.23 +0.33 -45.67 +7.71 +1.43 +3.2 +27.77 2008-2012 -1.86 +14.86 -25.64 +2.65 +13.46 +123.9 (only more than 100 is significant)DDD = defined daily dose, ACE = Angiotensin-converting enzyme; Standard Treatment Guidelines (STG) for hypertension management implemented in 2009 at UNRWA primary health clinics (PHCs). **The binomial proportion 95 confidence interval excludes the null value of zero difference (P-value <0.05).combination product procured in 2012, all medication products were single-ingredient products. We describe the prevalence of antihypertensive utilization measured as DDD/100 persons with hypertension between 2008 and 2012. We used simple linear regression models to calculate the trend (change in DDD per 100 hyperten.