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Trends in antihypertensive drug therapy of ambulatory patients by US office-based physicians
1Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. cn80n@nih.gov.
Insights
Physician prescribing for hypertension generally aligned with Joint National Committee (JNC) guidelines. While use of calcium channel blockers and ACE inhibitors increased, diuretics and beta-blockers remained prevalent, aligning with JNC V recommendations.
Area of Science:
- Cardiovascular Medicine
- Pharmacotherapy
- Public Health
Background:
- Hypertension management guidelines evolve over time.
- Physician prescribing patterns may not always align with clinical guidelines.
- Understanding trends in antihypertensive drug therapy is crucial for public health.
Purpose of the Study:
- To assess trends in antihypertensive drug therapy from 1980-1995.
- To compare these trends with Joint National Committee (JNC) guidelines.
- To evaluate physician adherence to hypertension treatment recommendations.
Main Methods:
- Analysis of US office-based physician visits for hypertension (1980, 1985, 1990, 1995).
- Utilized data from the National Ambulatory Medical Care Surveys.
- Compared prescribing trends with JNC reports on hypertension detection, evaluation, and treatment.
Main Results:
- No significant trend in visits without antihypertensive drugs (20-27%).
- Increased use of calcium channel blockers and ACE inhibitors.
- Decreased use of diuretics; however, diuretics and beta-blockers comprised 53% of visits in 1995, aligning with JNC V.
Conclusions:
- Physician prescribing generally followed JNC guidelines.
- Shift in preferred antihypertensive drug classes observed over the study period.
- Diuretics and beta-blockers remained important in hypertension management, consistent with JNC V.
Abstract:
This study assessed trends from 1980 to 1995 in ambulatory patients' antihypertensive drug therapy by US office-based physicians for visits in which hypertension was the principal diagnosis and compared these trends with the respective guidelines given in 5 Joint National Committee (JNC) Reports on Detection, Evaluation, and Treatment of High Blood Pressure published around the same time period. Data from the National Center for Health Statistics' National Ambulatory Medical Care Surveys for 1980, 1985, 1990, and 1995 were used. From 1980 to 1995, there was no significant trend in the percentage of hypertension visits that did not mention any antihypertensive drug (20% to 27%). Further analyses focused on those hypertension visits in which at least 1 antihypertensive drug was used. Across the years, antihypertensive drug visits mentioning calcium channel blockers or ACE inhibitors significantly increased; those noting diuretics significantly decreased. However, in 1995, antihypertensive drug visits that included a diuretic and/or a beta-adrenergic blocker equalled 53%; these are the antihypertensive drug classes preferred by the JNC V. Physician antihypertensive drug prescribing was generally consistent with the basic antihypertensive drug guidelines of the JNC reports.
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