Journal of General Internal Medicine

, Volume 18, Issue 12, pp 977–983

Misperceptions about β-blockers and diuretics

A national survey of primary care physicians
  • Peter A. Ubel
  • Christopher Jepson
  • David A. Asch
Original Articles


BACKGROUND: Based on a series of clinical trials showing no difference in the effectiveness or tolerability of most major classes of antihypertensive medications, the Joint National Commission on High Blood Pressure Treatment recommends that physicians prescribe β-blockers or diuretics as initial hypertensive therapy unless there are compelling indications for another type of medication. Nevertheless, many physicians continue to favor more expensive medications like angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers as first line agents. The persistent use of these agents raises questions as to whether physicians perceive ACE inhibitors and calcium channel blockers to be better than β-blockers and diuretics.

METHODS: We surveyed 1,200 primary care physicians in 1997, and another 500 primary care physicians in 2000, and asked them to estimate the relative effectiveness and side effects of 4 classes of medication in treating a hypothetical patient with uncomplicated hypertension: ACE inhibitors, β-blockers, calcium channel blockers, and diuretics. In addition, we asked them to indicate whether they ever provided free samples of hypertension medications to their patients.

RESULTS: Perceptions of the relative effectiveness and side effects of the 4 classes of hypertension medications did not significantly change over the 3 years, nor did prescription recommendations. Physicians perceive that diuretics are less effective at lowering blood pressure than the other 3 classes (P<.001). They also perceive that β-blockers are less tolerated than the other 3 classes (P<.001). In a multivariate model, perceptions of effectiveness and tolerability displayed significant associations with prescription preference independent of background variables. The only other variable to contribute significantly to the model was provision of free medication samples to patients.

CONCLUSIONS: Despite numerous clinical trials showing no difference in the effectiveness or side-effect profiles of these 4 classes of drugs, most physicians believed that diuretics were less effective and β-blockers were less tolerated than other medications. Moreover, their prescription practices were associated with their provision of free samples provided by pharmaceutical representatives, even after adjusting for other demographic characteristics. Efforts to increase physicians’ prescribing of β-blockers and diuretics may need to be directed at overcoming misunderstandings about the effectiveness and tolerability of these medicines.

Key words

hypertension treatment physician survey pharmaceutical promotion 


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Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Peter A. Ubel
    • 1
    • 2
    • 3
  • Christopher Jepson
    • 4
  • David A. Asch
    • 4
    • 5
    • 6
  1. 1.Received from VA Health Services Research & Development Center of ExcellenceVA Ann Arbor Healthcare SystemUSA
  2. 2.Division of General Internal MedicineUniversity of MichiganUSA
  3. 3.Program for Improving Health Care DecisionsUniversity of MichiganAnn Arbor
  4. 4.Division of General Internal MedicineUniversity of Pennsylvania School of MedicineUSA
  5. 5.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaUSA
  6. 6.Center for Health Equity Research and Promotion, Veterans Affairs Medical CenterPhiladelphia

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