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The influence of national guidelines on antihypertensive prescribing patterns
1Medical Service (III), Department of Veterans Affairs NCHCS, 10535 Hospital Way, Mather, CA 95655, USA. siegel.david@martinez.va.gov
Insights
Expert medical panel recommendations, like those from the Fifth Joint National Committee on High Blood Pressure (JNC V), did not significantly alter prescribing patterns for hypertension medications. Calcium antagonists and ACE inhibitors remained common despite JNC V guidance.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Practice Guidelines
Background:
- Expert medical panels generate recommendations to guide clinical practice for various health conditions.
- The effectiveness of these recommendations in influencing actual medical practice is often uncertain.
- The Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) released guidelines in 1993.
Purpose of the Study:
- To evaluate the impact of the 1993 JNC V guidelines on antihypertensive prescribing patterns.
- To determine if JNC V recommendations influenced the choice of first-line medications for hypertension.
Main Methods:
- Analysis of national retail pharmacy dispensing data from 1992 and 1995.
- Evaluation of antihypertensive prescribing patterns within US Veterans Affairs (VA) medical facilities during the same period.
- Comparison of drug usage before and after the JNC V publication.
Main Results:
- Calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors were the most frequently prescribed antihypertensive drugs in both 1992 and 1995.
- Prescribing patterns in retail pharmacies showed increased use of calcium antagonists and ACE inhibitors and decreased use of diuretics and beta-blockers from 1992 to 1995.
- Similar trends in antihypertensive drug use were observed in VA facilities, indicating limited influence of JNC V recommendations.
Conclusions:
- The JNC V guidelines appear to have had minimal impact on the prescribing habits for hypertension management.
- The study highlights a potential disconnect between expert recommendations and clinical practice regarding antihypertensive medication choices.
- Further research is needed to understand the reasons for this lack of influence and to develop more effective strategies for provider education.
Abstract:
Efforts to influence medical practice include the formation of expert medical panels who make recommendations for the evaluation and treatment of clinical problems. Despite the considerable expense and effort that go into these activities, it is unclear whether they are successful. Recent studies have evaluated whether recommendations from the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) published in 1993 influenced antihypertensive prescribing patterns. These included a national study of medications dispensed by retail pharmacies and an evaluation of antihypertensive prescribing patterns in US Veterans Affairs (VA) medical facilities. Despite recommendations from JNC V that hydrochlorothiazide and beta-blockers be used as first choice for most hypertensive patients, calcium antagonists and angiotensin converting enzyme (ACE) inhibitors were the most common drugs prescribed for hypertension in both 1992 (before JNC V) and 1995 (after JNC V). In retail pharmacies, changes in antihypertensive drug dispensing patterns from 1992 to 1995 reflected increased use of calcium antagonists and ACE inhibitors and decreased use of diuretics and beta-blockers, suggesting that JNC V recommendations had little effect on prescribing patterns. Similar patterns of antihypertensive drug use were found in VA facilities. The reasons for the lack of influence of JNC V recommendations on antihypertensive prescribing patterns must be explored and alternative ways of educating health care providers implemented.