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Factors associated with antihypertensive prescribing
M B Nichol1, J E Margolies, M A Gill
1Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles 90033, USA.
Insights
Older patients and those with heart failure are more likely to receive combination hypertension therapy. Prescription patterns show a shift towards calcium antagonists and away from diuretics and beta-blockers.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases.
- Effective hypertension management is crucial for reducing healthcare burden.
Purpose of the Study:
- Investigate factors influencing hypertension treatment approaches.
- Analyze patient and physician characteristics associated with antihypertensive prescribing patterns.
Main Methods:
- Analysis of three cross-sectional national surveys (1989-1991) of patient-physician encounters.
- Utilized multiple variable logistic regression to identify predictors of antihypertensive prescriptions and combination therapy.
Main Results:
- 69-75% of encounters resulted in antihypertensive prescriptions.
- Prescribing trends shifted from diuretics/beta-blockers to calcium antagonists.
- Older patients (>65 years), those with congestive heart failure (CHF), and specific physician specialties were more likely to receive combination therapy.
Conclusions:
- National prescribing patterns for hypertension align with existing literature.
- Patient age, multiple diagnoses, cardiologist visits, and CHF diagnosis significantly predict combination antihypertensive therapy.
Objective:
To investigate factors associated with treatment approaches to hypertension, a major risk factor for coronary heart and cerebrovascular disease and significant healthcare problem in the US. The study reports on three cross-sectional national surveys of patient-physician encounters.
Population:
Visits were selected for adults with hypertension diagnoses from the National Ambulatory Medical Care Surveys, which represent office encounters during a given year. Years of observation included 1989, 1990, and 1991.
Methods:
Multiple variable logistic regression was used to identify predisposing need, enabling, and health utilization characteristics associated with whether the visit resulted in a prescription of an antihypertensive. Additionally, the association of these visits with combination therapy is determined.
Results:
For each of the 3 years, 69-75% of the encounters were associated with a prescription for drugs to treat hypertension. Prescribing is consistent with current literature demonstrating decreasing reliance on diuretics and beta-blockers, and increasing reliance on calcium antagonists. Combination therapy decreased as a percentage of prescriptions in 1990 and 1991. Variables associated with receiving an antihypertensive prescription included predisposing characteristics (patient age > 65 y), need characteristics (diagnosis of congestive hear failure [CHF]), and health utilization characteristics (physician specialty, previous diagnosis of hypertension). The most significant variables associated with combination therapy were predisposing characteristics (patient age > 65 y), need (CHF diagnosis, diagnosis of hypertension with end organ involvement), and health utilization characteristics (physician specialty).
Conclusions:
These national estimates reinforce previous regional data regarding the categories of hypertension medications used. Patient visits involving multiple diagnoses, cardiologists, or patients older than 65 years, are more likely to generate prescriptions for combination antihypertensive therapy.