Treatment of hypertension in patients with comorbidities - Results from the study of hypertensive prescribing practices (SHyPP)

Approximately 50 million people have hypertension. Many agents with differi ng efficacy, side effects, dosing schedules, and costs are available to tre at hypertension. Joint National Committee (JNC) guidelines attempt to simpl ify this decision by recommending specific agents based on special consider ations such as comorbidities. The objective of this study was to survey pri mary care physicians' antihypertensive prescribing practices and their trea tment recommendations for patients with comorbidities. A direct mail survey was sent to a national random sample of 500 office-based primary care inte rnists, family practitioners, and general practitioners. There were no sign ificant differences between initial treatment recommendations at the time o f the survey and those recommended before the survey. However, there were s everal therapeutic classes whose reported utilization for specific comorbid ities significantly changed over 18 months. Angiotensin converting enzyme ( ACE) inhibitors reportedly increased in patients with congestive heart fail ure and diabetes. In addition the reported use of selective P-blockers incr eased for patients with a history of myocardial infarction. Physicians did not follow JNC recommendations when initiating treatment in black patients, older patients, or those with mild renal failure. Younger physicians were more likely than older physicians to select agents consistent with guidelin e recommendations. Physicians did not adhere to JNC guidelines when initiat ing treatment in patients with comorbidities; however, more physicians are prescribing recommended agents today as compared to 18 months ago. Younger physicians were more likely to prescribe agents consistent with the guideli nes. More direct efforts are needed to ensure awareness and compliance with these guidelines. (C) 1999 American Journal of Hypertension, Ltd.