[Rational prescribing and cost reduction in the treatment of arterial hypertension: a simulation exercise]

Cost of antihypertensive drugs in Spain raises 100.000 millions of pesetas. The utilization of new drugs more expensive than classics diuretics and beta blockers is the main reason of this cost increase.The Joint National Commission on Hypertension 6th Report supports the utilization of diuretics and beta blockers as the first choice in patients without any special condition, based in their best efficience. Other professional group don't point out any therapeutic drugs because each of them have their indication. Health authorities have implemented measures intended more to achieve savings than to improve prescriptions. There are not any studies which demonstrate that the second type of measures are more efficient than first one.

To realize an economic evaluation, of a program of blood hypertension treatment taking and not taking into account the The Joint National Commission on Hypertension 6th Report.

Descriptive, prescription-indication study. Cost minimization. Health center from Valencia (Spain). Three hundred and thirteen patients were studied, randomly selected. Three strategy of cost decrease were considered: a) same prescription profile using the cheapest drugs, b) change of profile taken into account JNC-VI recommendations using the original drugs, and c) second option, but using the cheapest drugs.

Ninety seven percent of diuretics had specific indications, 84% of beta blockers, 64.5% of IECAS, 31.6% of alfa blockers and 13% de calcium channel blockers. Diuretics were counter-indicated in 3.5% of patients, beta blockers in 10.5%, and both in 3.1%. Total cost of the unmodifed prescription was 12.412.839 pesetas, cost of the first strategy was 10.067.107, of the second 5.311.783 pesetas and of the third 1.999.094 pesetas.

Our prescription profile don't follow JNC VI recommendations and this is not justified on indications or counterindications of diuretics and beta blockers. Following JNC VI is more efficient than looking only for the cheapest drug.