Skip to main content
PMC home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1998 Feb;44:294-8, 301-2.

Treating hypertension. Are the right drugs given to the right patients?

M D Beaulieu 1, L Dufresne 1, D LeBlanc 1
PMCID: PMC2277613  PMID: 9512833

Abstract

OBJECTIVE: To evaluate whether physicians are prescribing antihypertensive drugs appropriately and according to the recommendations of the Canadian Hypertension Society. DESIGN: Retrospective cohort study. SETTING: Family medicine teaching clinic in Montreal. PARTICIPANTS: A cohort of 183 patients followed between 1993 and 1995. Of 350 patients registered at the clinic, 167 were excluded because diagnosis of hypertension was not supported by chart review, their charts contained insufficient information, they were pregnant or younger than 18 years, or they had secondary hypertension and complex medical conditions. MAIN OUTCOME MEASURES: The dependent variable was the antihypertensive medication. Independent variables were age and sex of patients, duration of hypertension, total number of visits and number of visits for hypertension, number of physicians consulted at the clinic, associated medical conditions, diagnosis of target organ damage, blood pressure readings, and associated medications. RESULTS: Diuretics were prescribed most frequently (45.9%). Angiotensin-converting enzyme (ACE) inhibitors ranked second (28.4%), followed by calcium channel blockers (26.2%) and beta-blockers (18.0%). Age, sex, duration of hypertension, and blood pressure readings were not associated with medications. Prescription of beta-blockers was strongly associated with previous myocardial infarction, but not with diagnosis of angina pectoris. Patients with contraindications to beta-blockers were less likely to receive them and more likely to receive calcium channel blockers. Only 32% of diabetic patients received ACE inhibitors. CONCLUSION: Results suggest that some prescriptions for antihypertensive medications are inappropriate, but that physicians are following some of the Canadian Hypertension Society's recommendations. A better understanding of physicians' prescribing behaviours could help target continuing education interventions to improve prescribing for hypertension.

Full text

PDF
297

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adamson T. E., Rodnick J. E., Guillion D. S. Family physicians and general internists: do they treat hypertensive patients differently? J Fam Pract. 1989 Jul;29(1):93–99. [PubMed] [Google Scholar]
  2. Arroll B., Jenkins S., North D., Kearns R. Management of hypertension and the core services guidelines: results from interviews with 100 Auckland general practitioners. N Z Med J. 1995 Feb 22;108(994):55–57. [PubMed] [Google Scholar]
  3. Aubin M., Vézina L., Fortin J. P., Bernard P. M. Effectiveness of a program to improve hypertension screening in primary care. CMAJ. 1994 Feb 15;150(4):509–515. [PMC free article] [PubMed] [Google Scholar]
  4. Beto J. A., Bansal V. K. Quality of life in treatment of hypertension. A metaanalysis of clinical trials. Am J Hypertens. 1992 Mar;5(3):125–133. doi: 10.1093/ajh/5.3.125. [DOI] [PubMed] [Google Scholar]
  5. Boissel J. P., Collet J. P., Lion L., Ducruet T., Moleur P., Luciani J., Milon H., Madonna O., Gillet J., Gerini P. A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. The OCAPI Study Group. Optimiser le Choix d'un Anti-hypertenseur de Première Intention. J Hypertens. 1995 Sep;13(9):1059–1067. doi: 10.1097/00004872-199509000-00018. [DOI] [PubMed] [Google Scholar]
  6. Dawson K. G., McKenzie J. K., Ross S. A., Chiasson J. L., Hamet P. Report of the Canadian Hypertension Society Consensus Conference: 5. Hypertension and diabetes. CMAJ. 1993 Sep 15;149(6):821–826. [PMC free article] [PubMed] [Google Scholar]
  7. Dickerson J. E., Garratt C. J., Brown M. J. Management of hypertension in general practice: agreements with and variations from the British Hypertension Society guidelines. J Hum Hypertens. 1995 Oct;9(10):835–839. [PubMed] [Google Scholar]
  8. Furberg C. D., Berglund G., Manolio T. A., Psaty B. M. Overtreatment and undertreatment of hypertension. J Intern Med. 1994 May;235(5):387–397. doi: 10.1111/j.1365-2796.1994.tb01093.x. [DOI] [PubMed] [Google Scholar]
  9. Gong L., Zhang W., Zhu Y., Zhu J., Kong D., Pagé V., Ghadirian P., LeLorier J., Hamet P. Shanghai trial of nifedipine in the elderly (STONE). J Hypertens. 1996 Oct;14(10):1237–1245. doi: 10.1097/00004872-199610000-00013. [DOI] [PubMed] [Google Scholar]
  10. Jerome M., Xakellis G. C., Angstman G., Patchin W. Initial medication selection for treatment of hypertension in an open-panel HMO. J Am Board Fam Pract. 1995 Jan-Feb;8(1):1–6. [PubMed] [Google Scholar]
  11. Johannesson M., Borgquist L., Jönsson B. The costs of treating hypertension in Sweden. An empirical investigation in primary health care. Scand J Prim Health Care. 1991 Sep;9(3):155–160. doi: 10.3109/02813439109018511. [DOI] [PubMed] [Google Scholar]
  12. Jones J. K., Gorkin L., Lian J. F., Staffa J. A., Fletcher A. P. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ. 1995 Jul 29;311(7000):293–295. doi: 10.1136/bmj.311.7000.293. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ogilvie R. I., Burgess E. D., Cusson J. R., Feldman R. D., Leiter L. A., Myers M. G. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of essential hypertension. CMAJ. 1993 Sep 1;149(5):575–584. [PMC free article] [PubMed] [Google Scholar]
  14. Palmer A. J., Fletcher A. E., Rudge P. J., Andrews C. D., Callaghan T. S., Bulpitt C. J. Quality of life in hypertensives treated with atenolol or captopril: a double-blind crossover trial. J Hypertens. 1992 Nov;10(11):1409–1416. doi: 10.1097/00004872-199211000-00014. [DOI] [PubMed] [Google Scholar]
  15. Psaty B. M., Koepsell T. D., Yanez N. D., Smith N. L., Manolio T. A., Heckbert S. R., Borhani N. O., Gardin J. M., Gottdiener J. S., Rutan G. H. Temporal patterns of antihypertensive medication use among older adults, 1989 through 1992. An effect of the major clinical trials on clinical practice? JAMA. 1995 May 10;273(18):1436–1438. [PubMed] [Google Scholar]
  16. Psaty B. M., Savage P. J., Tell G. S., Polak J. F., Hirsch C. H., Gardin J. M., McDonald R. H., Jr Temporal patterns of antihypertensive medication use among elderly patients. The Cardiovascular Health Study. JAMA. 1993 Oct 20;270(15):1837–1841. [PubMed] [Google Scholar]
  17. Reeves R. A., Fodor J. G., Gryfe C. I., Patterson C., Spence J. D. Report of the Canadian Hypertension Society Consensus Conference: 4. Hypertension in the elderly. CMAJ. 1993 Sep 15;149(6):815–820. [PMC free article] [PubMed] [Google Scholar]
  18. Romm F. J., Putnam S. M. The validity of the medical record. Med Care. 1981 Mar;19(3):310–315. doi: 10.1097/00005650-198103000-00006. [DOI] [PubMed] [Google Scholar]
  19. Sever P., Beevers G., Bulpitt C., Lever A., Ramsay L., Reid J., Swales J. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. BMJ. 1993 Apr 10;306(6883):983–987. doi: 10.1136/bmj.306.6883.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sinclair B. L., Ashton T., Jackson R., Beaglehole R. Trends in antihypertensive medication costs in a cohort of Aucklanders 1982-87. N Z Med J. 1989 Oct 11;102(877):521–523. [PubMed] [Google Scholar]
  21. Steven I. D., Wilson D. H., Wakefield M. A., Beilby J., Coffey G. A., Esterman A. J., Golding A. P., Graham N. M., Litt J. C., Rohrsheim R. A. South Australian hypertension survey. General practitioner experiences with drug treatment. Med J Aust. 1992 May 4;156(9):641–644. [PubMed] [Google Scholar]
  22. Strømme H. K., Botten G. Factors relating to the choice of antihypertensive and hypnotic drug treatment in old patients. A study of a sample of Norwegian general practitioners. Scand J Prim Health Care. 1992 Dec;10(4):301–305. doi: 10.3109/02813439209014078. [DOI] [PubMed] [Google Scholar]
  23. Troein M., Arneson T., Råstam L., Pirie P. L., Selander S., Luepker R. V. Reported treatment of hypertension by family physicians in Sweden and Minnesota: a physician survey of practice habits. J Intern Med. 1995 Sep;238(3):215–221. doi: 10.1111/j.1365-2796.1995.tb00925.x. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES