FACTORS ASSOCIATED WITH ANTIHYPERTENSIVE PRESCRIBING

OBJECTIVE: TO investigate factors associated with treatment approaches to hypertension a major risk factor for coronary heart and cerebrovas cular disease and a significant healthcare problem in the US. The stud y reports on three cross-sectional national surveys of patient-physici an encounters. POPULATION: Visits were selected for adults with hypert ension diagnoses from the National Ambulatory Medical Care Surveys, wh ich represent office encounters during a given year. Years of observat ion included 1989, 1990, and 1991. METHODS: Multiple variable logistic regression was used to identify predisposing, need enabling, and heal th utilization characteristics associated with whether the visit resul ted in a prescription of an antihypertensive. Additionally, the associ ation of these visits with combination therapy is determined. RESULTS: For each of the 3 years, 69-75% of the encounters were associated wit h a prescription for drugs to treat hypertension. Prescribing is consi stent with current literature demonstrating decreasing reliance on diu retics and beta-blockers, and increasing reliance on calcium antagonis ts. Combination therapy decreased as a percentage of prescriptions in 1990 and 1991. Variables associated with receiving an antihypertensive prescription included predisposing characteristics (patient age > 65 y), need characteristics (diagnosis of congestive heart failure [CHF]) , and health utilization characteristics (physician specialty, previou s diagnosis of hypertension). The most significant variables associate d with combination therapy were predisposing characteristics (patient age > 65 y), need (CHF diagnosis, diagnosis of hypertension with end o rgan involvement), and health utilization characteristics (physician s pecialty). CONCLUSIONS: These national estimates reinforce previous re gional data regarding the categories of hypertension medications used. Patient visits involving multiple diagnoses, cardiologists, or patien ts older than 65 years, are more likely to generate prescriptions for combination antihypertensive therapy.