Antihypertensive pharmacotherapy: Does prescribing follow national guideline recommendations?

Edward Roy Westrick, University of Rhode Island


Background. Hypertension is a common chronic disease, which is expensive to treat and has serious but preventable long-term complications. It should be possible to optimize antihypertensive therapy such that the most prevention is obtained with the least cost. This optimization can be approached through adherence to current national evidence-based practice guidelines for the treatment of hypertension. ^ Objectives. The objectives of this study are: (1) to test hypotheses regarding comorbidities and prescribing in hypertension and, (2) to identify opportunities to improve adherence to treatment guidelines for hypertension. ^ Methods. The study employs a nonconcurrent cohort research design for hypothesis testing in incident uncomplicated cases of hypertension. The practice recommendations from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were translated into operational definitions of uncomplicated hypertension, relevant comorbidities, and drug class prescribing. Administrative claims data were used to classify cases with respect to diseases and classes. These classifications were used to test for predicted disease-class associations. ^ Results. Statistically significant positive associations were found between: Angiotensin Converting Enzyme (ACE) Inhibitors and diuretics in congestive heart failure (CHF); beta blocker and calcium channel blocker (CCB) prescribing in coronary artery disease (CAD) ACE Inhibitor prescribing in diabetes mellitus and renal failure; and alpha blocker prescribing in benign prostatic hypertrophy. Statistically significant negative associations were found between: beta blocker prescribing in chronic obstructive pulmonary disease, diabetes mellitus, and dyslipidemia; and diuretic prescribing in dyslipidemia. Diuretics and beta blockers are (38.8%) are not used more frequently as first line therapy than CCBs and ACE Inhibitors (59.7%) in uncomplicated hypertension. ^ Conclusions. The predicted associations were largely confirmed, providing evidence for appropriate prescribing in hypertension. Analysis of claims data can be a useful method of measuring prescribing practices in hypertension. The details of this methodology and its limitations are discussed. The major opportunity for improvement relates to under-prescribing of diuretics and beta-blockers, and over-prescribing of calcium channel blockers and ACE inhibitors in uncomplicated hypertension. ^

Subject Area

Health Sciences, Medicine and Surgery|Health Sciences, Pharmacy

Recommended Citation

Edward Roy Westrick, "Antihypertensive pharmacotherapy: Does prescribing follow national guideline recommendations?" (1999). Dissertations and Master's Theses (Campus Access). Paper AAI9960033.