Selective use of calcium channel blockers to treat high-risk hypertensive patients

Purpose While hypertension treatment is aimed at reducing cardiovascular di sease (CVD) risk, there are reports of association between calcium channel blockers (CCB) use and increased risk. However, these studies may be mislea ding if CCBs are used selectively in high-risk patients. Methods - We conducted a knowledge, attitudes, and practice (KAP) survey by mail of a stratified random sample of 10,000 US cardiologists, internists, and family/general practitioners. Completed surveys were received from 102 3 physicians, and population means and frequencies (+/-standard errors) wer e estimated. Results - While only 36.3 (+/-0.6)% of physicians use long-acting CCBs for mild hypertension without additional risk factors, use increases with moder ate or severe hypertension and other risk factors, including history of myo cardial infarction (48.4 (+/-0.6)%), family history of CVD (54.6 (+/-0.6)%) , diabetes (57.3 (+/-0.6)%), and angina (63.8 (+/-0.5)%). Physicians use CC Bs as initial therapy for 24.8 (+/-0.3)% of mildly and 33.1 (+/-0.3)% of mo derately hypertensive patients, and add CCBs to the regimens of 39.0 (+/-0. 3)% of moderately hypertensive patients not controlled on other antihyperte nsive therapy. In multiple regression analysis, the proportion of hypertens ive patients treated with CCBs was significantly elevated among geriatricia ns and physicians who believe severity of hypertension is an indication for their use. Conclusion - These findings suggest that CCBs are used selectively for high -risk hypertensive patients. Copyright (C) 2000 John Wiley & Sons, Ltd.