Hypertension management of medical aid patients attending private practices

Objectives. The study aimed to describe the treatment status of hypertensiv e patients and the prescribing patterns of private medical practitioners tr eating medical aid scheme patients with hypertension. Method. Data on hypertensive patients belonging to medical aid schemes were provided to the drug utilisation review consultancy, Quality Health Servic es(QHS), by private medical practitioners. The data were computerised and i ncluded the age and gender of the patient, the diastolic and systolic blood pressure (BP), the medication prescribed for the condition and the qualifi cations of the reporting doctor. All the prescribed drugs were categorised into 12 drug classes and combination preparations had each constituent cate gorised. The level of BP allowed the degree of BP control to be described a s controlled (< 140/90 mmHg), borderline (140/90 - < 160/95 mmHg) and uncon trolled (greater than or equal to 160/85 mmHg). Results. Included in the study were 11 696 hypertensive patients (46.3% mal e and 53.7% female) and the 3 503 doctors who cared for them. The systolic BP showed an age-related increase, but the diastolic BP did not. The level of BP control was high, with less than a quarter of patients having uncontr olled hypertension. The most frequently prescribed drug class was angiotens in-converting enzyme (ACE) inhibitors (32.2%). Beta-blockers accounted for 20.8% and calcium antagonists for 14% of all prescriptions. Thiazide and th iazide-like diuretics on their own accounted for only 7.8% of prescriptions . However, a further 13.8% of prescriptions contained this class of diureti cs in combination with other drug classes. Diuretics of all classes taken o n their own or in combination were used by 33.9% of patients. Conclusions. Good levels of hypertension control were reported for hyperten sive patients by their private practitioners. Almost half of all prescripti ons were for the newer and more costly antihypertensive drugs (ACE inhibito rs and calcium antagonists), although their effectiveness in reducing long- term complications of hypertension is still unproven. Furthermore, these pr escribing patterns do not conform to those recommended by the Southern Afri can Hypertension Society's hypertension management guidelines.