Influence of cardiovascular risk factors on antihypertensive treatment in general practice

Objective: The World Health Organization Guidelines on the management of Hy pertension recommends to take care of cardiovascular risk factors for selec ting drug treatment. The aim of the study was to analyze relationship betwe en cardiovascular risk factors and use of anti hypertensive drugs in genera l practice in France. Methods: This was a national cross sectional epidemiological survey perform ed by 3,152 general practitioners between September 1999 and May 2000. Each investigator had to include 5 consecutive hypertensives (HT) (BP greater t han or equal to 140/90 or presence of antihypertensive treatment). Cardiova scular risk factors, antihypertensive treatments and office BP were recorde d. A stepwise logistic regression analysis was performed for each class of antihypertensive treatment in order to determine risk factors associated wi th prescription. Significant threshold was fixed at 0.05. Results are expre ssed in the form of odds ratios (OR). Results: 14,551 treated hypertensives (mean age 60 +/- 10 years, male 56%) were analyzed. Sixteen per cent of patients were diabetics, 17% current smo kers and the mean value of cholesterol was 2.29 +/-0.37 g/L. ACE inhibitors , diuretics, beta -blockers (BB), dihydropyridines, angiotensin II antagoni sts (AAII). non DHP calcium antagonists (CA) were prescribed in respectivel y 47%, 35%, 28%, 18%, 14% and 12% of patients. The main risk factors associ ated with each kind of prescription was diabetes for ACE (OR=1.36), coronar y artery disease for BB, DHP and non-DHP CA (OR=2.53. 1.51; 1.4 respectivel y) and BMI for AAII (OR=1.03). OR>1 indicates that risk factors was positiv ely linked to prescription. Age had minor influence on selecting drug treat ment. Conversely to BB and AAII, the use of ACE and non-DHP CA increases wi th presence of diabetes and cholesterol increase. Conclusion: In general practice, presence of cardiovascular risk factors in fluences mildly management of hypertension. Conversely to BB, ACE are more prescribed in HT with metabolic disorders.