Management of hypertension by general practitioners: An Italian observational study
Data on patients receiving antihypertensive therapy were collected from 20 general practitioners (GPs) in Campania, Italy, to determine the prescription of different antihypertensive classes and their use with other drugs for concomitant diseases, to investigate the main factors influencing antihypertensive choice, to document treatment outcome, and to assess adverse drug reactions (ADRs). Each GP completed a data card for each consultation that produced an antihypertensive prescription; 1900 cards were collected. The most frequently used antihypertensives were angiotensin-converting enzyme inhibitors (49.6%), calcium antagonists (24.8%), beta blockers (11.7%), angiotensin II-receptor blockers (5.5%), and alpha blockers (0.9%). In 82% of patients, blood pressure was reduced but did not reach normotensive levels. The choice of antihypertensive treatment was influenced by international guidelines (56%), clinical diagnosis (25%), concomitant diseases (8%), cost (4%), compliance (3%), and other factors (5%). ADRs—most often cough (35.7%), edema (22.7%), headache (13.3%), and tachycardia (7.8%)—occurred in 11.8% of patients.
Keywordsantihypertensive drug general practitioners guidelines
Prisant LM, Moser M. Hypertension in the elderly: can we improve results of therapy?Arch Intern Med.
Lloyd-Jones DM, Evans JC, Larson MG, O’Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community.Hypertension
. 2000;36:594–599.PubMedGoogle Scholar
Avanzini F, Alli C, Colombo P, Corsetti A, Colombo F, Tognoni G. Control of hypertension in Italy: results of the Study on Antihypertensive Treatment in General Practice (STAP). GItal Cardiol
. 1998;28:760–766.PubMedGoogle Scholar
Trenkwalder P, Hendricks P, Schoniger R, Rossberg J, Lydtin H, Hense HW. Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population: the prospective STEPHY II study.Eur Heart J.
Cranney M, Barton S, Walley T. The management of hypertension in the elderly by general practitioners in Merseyside: the rule of halves revisited.Br J Gen Pract.
Cushman WC. The clinical significance of systolic hypertension.Am J Hypertens
. 1998;11: 182S-185S.PubMedCrossRefGoogle Scholar
Steel N. Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey.BMJ.
Erdmann E. The management of heart-failure: an overview.Basic Res Cardiol.
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension guidelines for management of hypertension.J Hypertens
. 1999;17:151–183.Google Scholar
Mehta SS, Wilcoxs CS, Schulman KA. Treatment of hypertension in patients with comorbidities: results from the Study of Hypertensive Prescribing Practices (SHyPP).Am J Hypertens
. 1999;12: 333–340.PubMedGoogle Scholar
McAlister FA, Laupacis A, Teo KK, Hamilton PG, Montague TJ. A survey of clinician attitudes and management practices in hypertension.J Hum Hypertens
. 1997;11:413–419.PubMedCrossRefGoogle Scholar
Yapp CK, Taylor LS, Ow CY, Jamrozik K, Puddey IB. Hypertension management: a comparison of urban versus rural general practitioners in western Australia.Clin Exp Pharmacol Physiol
. 1995;22:447–449.PubMedCrossRefGoogle Scholar
Jamali AH, Tang WH, Khot UN, Fowler MB. The role of angiotensin receptor blockers in the management of chronic heart failure.Arch Intern Med.
Crucitti A, Cecchi E, Gensini GF, et al. Use of antihypertensive drugs in Italian hospitals.Pharm Res.
Rossi F et al.Basi Farmacologiche della Medicina
. Turin: UTET; 1997:237–339.Google Scholar
Olsen H, Klemetsrud T, Stokke HP, Tretli S, Westheim A. Adverse drug reactions in current antihypertensive therapy: a general practice survey of 2586 patients in Norway.Blood Press
. 1999; 8:94–101.PubMedCrossRefGoogle Scholar
Edwards PR, Steyn K, Walters L, Smart A, Gammon S, Lombard CJ. Hypertension management of medical aid patients attending private practices. SAfr Med J.
Bonapace S, Rajkumar C, Bulpitt CJ. Tailoring anti-hypertensive treatment in the elderly.J Hum Hypertens
. 1998;12:615–620.PubMedCrossRefGoogle Scholar
Morgan TO, Anderson AI, MacInnis RJ. ACE inhibitors, beta-blockers, calcium blockers and diuretics for the control of systolic hypertension.Am J Hypertens
. 2001;14:241–247.PubMedCrossRefGoogle Scholar
Degli Espositi E, Berto P, Buda S, Di Nardo AM, Sturani A. The Pandora Project: results of the pilot study.Am J Hypertens
. 1999;12:790–796.CrossRefGoogle Scholar
McAlister FA, O’Connor AM, Wells G, Grover SA, Laupacis A. When should hypertension be treated? The different perspectives of Canadian family physicians and patients.Can Med Assoc J.
Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly.Am J Hypertens
. 1997;10:697–704.PubMedCrossRefGoogle Scholar
Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice.Can Med Assoc J.
Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population.N Engl J Med.
© Health Communications Inc 2001