We evaluated the management of patients with hypertension (including d
rug prescribing) by US physicians, compared their prescribing to Natio
nal Institutes of Health (NIH) guidelines, and compared the pharmacoec
onomics of the prescribed antihypertensive drugs. A 1991 national US d
atabase, using physician-patient encounter forms, was our data source.
Results showed that physicians generally met the NIH guidelines regar
ding diagnostic/screening services, patient counselling/education, ant
ihypertensive drug prescribing and follow-up. Two areas should be the
foci of continuing medical education for US physicians. Firstly, physi
cians need to be reminded that centrally acting alpha-agonists are opt
imally used as supplemental antihypertensive drugs rather than as init
ial agents, which is how some physicians utilised them. Secondly, if o
nce-daily administration is used to promote patient compliance, physic
ians should be aware that, of the frequently prescribed first-line ant
ihypertensive drugs, hydrochlorothiazide, chlorthalidone and atenolol
presently have substantially less expensive once-daily dosage forms th
an other diuretics or beta-blockers, calcium antagonists or ACE inhibi
tors.