Physician gender and antihypertensive prescription pattern in primary care

To determine: (i) the gender-based differences of physicians in prescribing antihypertensive drugs in the management of hypertension; (ii) the influence of patient comorbidity such as diabetes mellitus on the gender-based pattern of antihypertensive prescription, and (iii) gender-based prescription patterns among family physicians (FPs) and general practitioners (GPs).

A survey study was carried out at 15 out of 20 health centres in Bahrain during May and June 2000. A total of 3971 prescriptions, issued to 2705 patients with uncomplicated hypertension and 1266 patients with diabetic hypertension by 77 FPs (female = 54, male = 23) and 41 GPs (female = 11, male = 30), were analysed.

As monotherapy, female physicians preferred ACE inhibitors (OR: 0.82, CI: 0.68-0.98, P = 0.033). In terms of overall drug utilization (monotherapy + combination therapy): (i) male physicians preferred beta blockers (OR: 1.17, CI: 1.03-1.31, P = 0.014) and diuretics (OR: 1.15, CI: 1.00-1.32, P = 0.047), while female physicians preferred methyldopa (OR: 0.73, CI: 0.56-0.94, P = 0.019); (ii) in uncomplicated hypertension, female physicians preferred calcium channel blockers (OR: 0.83, CI: 0.69-0.99, P = 0.038) and methyldopa (OR: 0.69, CI: 0.49-0.98, P = 0.042), and (iii) in diabetic hypertension, male physicians preferred beta blockers (OR: 1.26, CI: 1.00-1.57, P = 0.047). While female FPs prescribed methyldopa more extensively (OR: 0.66, CI: 0.47-0.92, P = 0.018), male GPs prescribed beta blockers (OR: 1.28, CI: 1.00-1.62, P = 0.046).

Within the same practice setting, gender-based differences in the prescription of antihypertensive drugs were seen. Such preference for a particular class of antihypertensives was also influenced by the presence of comorbidity in patients and, to a limited extent, by the training level of primary care physicians.