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Hypertension guidelines in elderly patients: is anybody listening?
Karen Tu1, Muhammad M Mamdani, Jack V Tu
1Institute for Clinical Evaluative Services, G106-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. karen.tu@ices.on.ca
Insights
Disseminating simplified hypertension guidelines to Ontario physicians did not significantly change prescribing patterns for elderly patients. Initial treatment choices for hypertension remained largely unaffected by the guideline distribution.
Area of Science:
- Geriatric Medicine
- Cardiovascular Pharmacology
- Health Services Research
Background:
- Previous hypertension guidelines for elderly patients recommended diuretics and beta-blockers.
- There is a need to understand how guideline dissemination impacts real-world prescribing practices.
Purpose of the Study:
- To examine initial antihypertensive medication prescribing trends in elderly patients in Ontario.
- To assess the impact of a government-sponsored simplified hypertension guideline dissemination program on prescribing patterns.
Main Methods:
- Utilized linked administrative databases for over 1.2 million elderly Ontario residents.
- Performed time series analysis from 1993 to 1998 to evaluate prescribing trends before and after guideline distribution in July 1995.
Main Results:
- Diuretic agents remained the most prescribed (35-38%).
- Beta-blocker (12% to 16%) and ACE inhibitor (27% to 32%) prescriptions increased, while calcium channel blocker prescriptions decreased (23% to 14%).
- Guideline dissemination showed no statistically significant effect on the initiation of any major antihypertensive drug class.
Conclusions:
- Simplified practice guidelines for hypertension did not significantly alter prescribing patterns in Ontario.
- The study highlights the limited impact of guideline dissemination on established physician prescribing habits for elderly hypertension management.
Purpose:
Previous guidelines for the management of uncomplicated hypertension in elderly patients have recommended diuretic agents and then beta-blockers. We examined trends in the initial treatment choice for elderly people with hypertension and the effects of a government-sponsored program to publish and disseminate a simplified version of the national guidelines for the treatment of hypertension to all physicians in Ontario, Canada.
Subjects And Methods:
Linked administrative databases containing information on the more than 1.2 million elderly residents in Ontario were used. Time series analysis was performed to determine prescribing trends from 1993 to 1998 for patients who began antihypertensive medication for the treatment of hypertension and to examine the effects of the simplified guidelines that were distributed in July of 1995.
Results:
Diuretic agents were the most commonly prescribed medications, with annual rates from 35% to 38% (P = 0.59) throughout the study. Beta-blocker prescribing rose from 12% to 16% (P <0.01), whereas angiotensin-converting enzyme (ACE) inhibitor prescribing rose from 27% to 32% (P <0.01). Prescriptions for calcium channel blockers dropped significantly, from 23% to 14% (P <0.01). However, the publication and dissemination of the Ontario hypertension guidelines had no statistically significant effects on the proportion of patients who began treatment with a diuretic agent (P = 0.55), beta-blocker, (P = 0.32), ACE inhibitor (P = 0.09), or calcium channel blocker (P = 0.07).
Conclusion:
The dissemination of simplified practice guidelines for hypertension did not have notable effects on prescribing patterns in Ontario.