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Selective use of calcium channel blockers to treat high-risk hypertensive patients

D M Huse1, L H Roht, S C Hartz

  • 1Innovative Clinical Solutions, Ltd., Burlington, Massachusetts, USA.

Pharmacoepidemiology and Drug Safety
|November 26, 2008
PubMed

Insights

Calcium channel blockers (CCBs) are selectively prescribed for high-risk hypertension patients, not mild cases. This selective use may explain previous associations between CCB use and increased cardiovascular disease risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Hypertension management aims to reduce cardiovascular disease (CVD) risk.
  • Previous studies suggested a potential increased risk with calcium channel blocker (CCB) use.
  • This association may be confounded by selective CCB prescription in high-risk individuals.

Purpose of the Study:

  • To investigate the prescribing patterns of CCBs in relation to hypertension severity and patient risk factors.
  • To determine if CCBs are used selectively in high-risk hypertensive patients.

Main Methods:

  • A mail-based Knowledge, Attitudes, and Practice (KAP) survey was conducted.
  • A stratified random sample of 10,000 US physicians (cardiologists, internists, family practitioners) was surveyed.
  • Data from 1023 completed surveys were analyzed to estimate population means and frequencies.

Main Results:

  • Long-acting CCBs were used for mild hypertension without risk factors by only 36.3% of physicians.
  • CCB use increased significantly with moderate/severe hypertension and risk factors like myocardial infarction (48.4%), CVD family history (54.6%), diabetes (57.3%), and angina (63.8%).
  • CCBs were used as initial therapy for 24.8% of mild and 33.1% of moderate hypertension cases, and added to regimens in 39.0% of uncontrolled moderate hypertension.

Conclusions:

  • Findings indicate that CCBs are selectively prescribed for patients with higher cardiovascular risk.
  • This selective prescribing pattern may explain conflicting findings in previous research on CCB and CVD risk.
Abstract

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