AN EVALUATION OF ANTIHYPERTENSIVE PRESCRIBING PRACTICES

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.