TREATING HYPERTENSION - ARE THE RIGHT DRUGS GIVEN TO THE RIGHT PATIENTS

OBJECTIVE To evaluate whether physicians are prescribing antihypertens ive drugs appropriately and according to the recommendations of the Ca nadian Hypertension Society. DESIGN Retrospective cohort study. SETTIN G Family medicine teaching clinic in Montreal. PARTICIPANTS A cohort o f 183 patients followed between 1993 and 1995. Of 350 patients registe red at the clinic, 167 were excluded because diagnosis of hypertension was not supported by chart review, their charts contained insufficien t information, they were pregnant or younger than 18 years, or they ha d secondary hypertension and complex medical conditions. MAIN OUTCOME MEASURES The dependent variable was the antihypertensive medication. I ndependent variables were age and sex of patients, duration of hyperte nsion, total number of visits and number of visits for hypertension, n umber of physicians consulted at the clinic, associated medical condit ions, diagnosis of target organ damage, blood pressure readings, and a ssociated medications. RESULTS Diuretics were prescribed most frequent ly (45.9%). Angiotensin-converting enzyme (ACE) inhibitors ranked seco nd (28.4%), followed by calcium channel blockers (26.2%) and beta-bloc kers (18.0%). Age, sex, duration of hypertension, and blood pressure r eadings were not associated with medications. Prescription of beta-blo ckers was strongly associated with previous myocardial infarction, but not with diagnosis of angina pectoris. Patients with contraindication s to beta-blockers were less likely to receive them and more likely to receive calcium channel blockers. Only 32% of diabetic patients recei ved ACE inhibitors. CONCLUSION Results suggest that some prescriptions for antihypertensive medications are inappropriate, but that physicia ns are following some of the Canadian Hypertension Society's recommend ations. A better understanding of physicians' prescribing behaviours c ould help target continuing education interventions to improve prescri bing for hypertension.