Sex differences in the medication choice for hypertension in general practice - A study with written case simulations

The objective of this study was to explore explanations for the preference of physicians to prescribe beta -blockers to hypertensive men and diuretics to hypertensive women. A qualitative study among 12 family physicians was conducted with a combina tion of written case simulations, semi-structured interviews and statements on attitudes of physicians towards antihypertensive drug choice. Among the male hypertensive cases the most frequently prescribed drugs were beta -blockers, whereas among the female hypertensive cases diuretics were more often prescribed. Physician characteristics associated with a preferr ed prescribing of beta -blockers to hypertensive men and diuretics to hyper tensive women were: older age (no residency in family medicine), the believ e that beta -blockers are more effective in men with regard to lowering blo od pressure and that diuretics are more effective in women, a non-evidence based attitude and a sex-related attitude towards the choice of beta -block ers and diuretics in general, and in particular towards the prescribing of beta -blockers to hypertensive men because men have a higher absolute risk of coronary heart disease than women. An additional explanation for these f indings may be the higher prevalence of ankle oedema among women. Patient c haracteristics associated with more prescribing of beta -blockers to hypert ensive men and diuretics to hypertensive women were: current employment and a "high-risk" profile in terms of blood pressure level and additional card iovascular risk factors. Although, most considerations underlying a preferr ed prescribing of beta -blockers to hypertensive men and diuretics to hyper tensive women were not evidence-based, the actual choice of antihypertensiv e drug (diuretic or beta -blocker) was evidence-based. These considerations may also play a role in the sex difference in the choice of calcium antago nists and angiotensin converting enzyme inhibitors and require further inve stigation.