High Blood Pressure / Hypertension

Treating hypertension: the drugs and the patients. Results

By Cardiologist on April 5th, 2010

Patient characteristics are presented in Table 2. Mean age of subjects was 67.2 years (range 25 to 93 years; median 68 years). Mean duration of hypertension was 4.2 years (range 2 to 9 years; median 3.9 years). Most patients were followed by just one physician (mean number of physicians 1.69): 160 (87.4%) by staff physicians and 23 (12.6%) by family medicine residents. Patients averaged 6.2 visits for hypertension during the 2-year study period. One third of patients had no associated medical conditions; slightly less than a third had signs of target organ damage. Mean blood pressure readings remained stable during the study period: 151/85 mm Hg ± 18/10 at the beginning and 147/84 mm Hg ± 18/8 at the end.

Of the 183 patients, 15 (8.2%) received no medication, 103 (56.3%) received one medication, and 65 (35.5%) received combined therapy (seven received three medications). We observed modifications to the therapeutic regimen for only 11 patients (6%). Enalapril (eg, Vasotec) was the most frequently prescribed drug (15% of all prescriptions), followed by the combination of hydrochlorothiazide and triamterene, Diazide and others (11.5%). Regrouped as classes of medications, however, diuretics ranked first (45.9%), followed by ACE inhibitors (28.4%), calcium channel blockers (26.2%), and β-blockers (18.0%). Figure 1 shows the distribution of antihypertensive medications for patients on monotherapy and combined therapy. The distribution of medications is comparable for both groups. Angiotensin-converting enzyme inhibitors and calcium channel blockers were preferred to β-blockers as monotherapy.

Figure 1. Distribution of prescriptions according to medication class for patients receiving monotherapy (n = 103) and for the complete sample of patients receiving pharmacotherapy (n = 168)

Only 20% of patients with coronary artery disease were receiving β-blockers; 32% of diabetics were receiving ACE inhibitors. Table 3 shows the results of logistic regression analyses. Age, sex, duration of hypertension, and blood pressure readings were not associated with any class of medication and do not appear in the table. Prescription of p-blockers was strongly associated with antecedents of myocardial infarction, but not with diagnosis of angina pectoris.

As expected, patients with contraindications to β-blockers were less likely to receive them and more likely to receive calcium channel blockers. Patients with target organ damage were less likely to receive thiazide diuretics, but more likely to receive ACE inhibitors (P= 0.09).

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