PERIPHERAL VASODILATORS AND THE MANAGEMENT OF PERIPHERAL VASCULAR-DISEASE AND RAYNAUDS-SYNDROME IN GENERAL-PRACTICE

There is no convincing evidence that peripheral vasodilators produce a ny significant improvement in exercise tolerance in patients with peri pheral vascular disease, and these drugs may do more harm than good. I n the treatment of severe Raynaud's syndrome, however, thymoxamine, pr azosin or niredipine is recommended. A descriptive study was carried o ut, firstly, to determine why these drugs are prescribed in general pr actice, and secondly, to describe the drug choices in the treatment of both Raynaud's syndrome and peripheral vascular disease in a represen tative sample of 22 practices in Northern Ireland. Of those patients p rescribed peripheral vasodilators 69.6% were diagnosed as peripheral v ascular disease, claudication or atherosclerosis. Over three-quarters of peripheral vasodilators prescribed were repeat prescriptions. Of th ose with Raynaud's syndrome only half were treated appropriately, and certainty of diagnosis did not guarantee appropriate treatment. Periph eral vasodilators accounted for the majority (51.5%) of items prescrib ed for peripheral vascular disease. A minority of patients with periph eral vascular disease (20.3%) were prescribed aspirin, and a smaller m inority (4.4%) had undergone amputation. Peripheral vasodilators were prescribed unnecessarily and inappropriately. Measures to promote evid ence-based treatment of both Raynaud's syndrome and peripheral vascula r disease in general practice need to be taken. (C) 1998 John Wiley gr Sons, Ltd.